Healthcare Provider Details

I. General information

NPI: 1346049822
Provider Name (Legal Business Name): MAUNDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 PROVIDENCE KNOLL DR
NORTH CHESTERFIELD VA
23236-2173
US

IV. Provider business mailing address

1228 PROVIDENCE KNOLL DR
NORTH CHESTERFIELD VA
23236-2173
US

V. Phone/Fax

Practice location:
  • Phone: 804-617-2498
  • 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: NABIL REZQUI
Title or Position: CO-FOUNDER
Credential:
Phone: 570-202-5800