Healthcare Provider Details

I. General information

NPI: 1043131634
Provider Name (Legal Business Name): OZYMANDIAS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 MOOREFIELD PARK DR STE 204
NORTH CHESTERFIELD VA
23236-3670
US

IV. Provider business mailing address

105 BUCKINGHAM DR
COLONIAL HEIGHTS VA
23834-1206
US

V. Phone/Fax

Practice location:
  • Phone: 804-506-0773
  • Fax:
Mailing address:
  • Phone: 804-506-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH R RUSSELL
Title or Position: OWNER
Credential: LPC, LSATP
Phone: 804-506-0773