Healthcare Provider Details

I. General information

NPI: 1023986742
Provider Name (Legal Business Name): THERAPY REALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR # 4966
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

4316 TILLMAN DR
VIRGINIA BEACH VA
23452-1247
US

V. Phone/Fax

Practice location:
  • Phone: 757-841-6045
  • Fax:
Mailing address:
  • Phone: 757-841-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LYNETTE ROMERO
Title or Position: CEO
Credential: LPC
Phone: 757-841-6045