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General NPI Number Information
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NPI Number | 1114479938
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Entity Type | Organization
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Legal Business Name | PAGANO WELLNESS CLINIC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 8527 MAYLAND DR STE 108
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City | RICHMOND
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State | VA
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Zip | 23294-4753
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Country | US
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Telephone | 804-409-4282
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Fax | 804-510-0044
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Provider Business Mailing Address
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Address Line | 8527 MAYLAND DR STE 108
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City | RICHMOND
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State | VA
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Zip | 23294-4753
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Country | US
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Telephone | 804-404-9695
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Fax | 804-510-0044
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Authorized Official
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Title or Position | OWNER
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Name | JENNA PAGANO
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Credential | MS, LMFT
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Telephone | 804-409-4282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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