Healthcare Provider Details

I. General information

NPI: 1114771532
Provider Name (Legal Business Name): POSITIVE MOODS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
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

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

V. Phone/Fax

Practice location:
  • Phone: 804-390-5704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: INDINESYA ZHAO
Title or Position: OWNER
Credential: LPC
Phone: 804-390-5704