Healthcare Provider Details

I. General information

NPI: 1114479938
Provider Name (Legal Business Name): PAGANO WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/23/2023
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 MAYLAND DR STE 108
RICHMOND VA
23294-4753
US

IV. Provider business mailing address

8527 MAYLAND DR STE 108
RICHMOND VA
23294-4753
US

V. Phone/Fax

Practice location:
  • Phone: 804-409-4282
  • Fax: 804-510-0044
Mailing address:
  • Phone: 804-404-9695
  • Fax: 804-510-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNA PAGANO
Title or Position: OWNER
Credential: MS, LMFT
Phone: 804-409-4282