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General NPI Number Information
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NPI Number | 1205620267
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Entity Type | Organization
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Legal Business Name | THE NOVA WELLNESS GROUP, LLC.
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 8401 MAYLAND DR # 4685
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City | HENRICO
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 804-854-5613
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 MAYLAND DR # 4685
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City | HENRICO
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 804-854-5613
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Fax |
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Authorized Official
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Title or Position | OWNER PSYCHOTHERAPIST
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Name | LATROYA TUCKER
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Credential | LCSW
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Telephone | 804-854-5613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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