Healthcare Provider Details

I. General information

NPI: 1972392363
Provider Name (Legal Business Name): NOWTHRIVE MENTAL HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18460 KERILL RD
TRIANGLE VA
22172-2082
US

IV. Provider business mailing address

18460 KERILL RD
TRIANGLE VA
22172-2082
US

V. Phone/Fax

Practice location:
  • Phone: 571-527-6737
  • Fax: 703-221-9191
Mailing address:
  • Phone: 571-527-6737
  • Fax: 703-221-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHIKA OKEOMA
Title or Position: OWNER OF ENTITY
Credential: DNP, CNP, PMHNP-BC
Phone: 571-527-6737