Healthcare Provider Details

I. General information

NPI: 1396600839
Provider Name (Legal Business Name): NICOLE ANDREA HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 N PARHAM RD STE 110
RICHMOND VA
23294-4410
US

IV. Provider business mailing address

2807 N PARHAM RD STE 110
RICHMOND VA
23294-4410
US

V. Phone/Fax

Practice location:
  • Phone: 804-418-3581
  • Fax: 804-707-7020
Mailing address:
  • Phone: 804-418-3581
  • Fax: 804-707-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: