Healthcare Provider Details

I. General information

NPI: 1588137913
Provider Name (Legal Business Name): FAMILY SUCCESS ON SPECTRUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 PATTERSON AVE STE 205
RICHMOND VA
23229-6430
US

IV. Provider business mailing address

8401 PATTERSON AVE STE 205
RICHMOND VA
23229-6430
US

V. Phone/Fax

Practice location:
  • Phone: 804-918-5206
  • Fax:
Mailing address:
  • Phone: 804-305-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MURTADHA A SHAHEEN
Title or Position: MANAGER
Credential:
Phone: 804-305-6849