Healthcare Provider Details

I. General information

NPI: 1477238772
Provider Name (Legal Business Name): DANDAN CLAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 FOREST HILL AVE
RICHMOND VA
23235-6876
US

IV. Provider business mailing address

9221 FOREST HILL AVE
RICHMOND VA
23235-6876
US

V. Phone/Fax

Practice location:
  • Phone: 804-326-5539
  • Fax: 804-535-4974
Mailing address:
  • Phone: 804-326-5539
  • Fax: 804-535-4974

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ZIEGFRED LACDAO DANDAN
Title or Position: CEO
Credential: LPC
Phone: 804-922-6166