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General NPI Number Information
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NPI Number | 1265288450
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Entity Type | Organization
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Legal Business Name | PROSPERITY WELLNESS LLC
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Dates
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Enumeration Date | 04/29/2024
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Last Update Date | 01/18/2026
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Provider Practice Location Address
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Address Line | 409 E LABURNUM AVE STE 5
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City | RICHMOND
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State | VA
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Zip | 23222-2105
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Country | US
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Telephone | 804-625-4645
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Fax |
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Provider Business Mailing Address
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Address Line | 409 E LABURNUM AVE STE 5
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City | RICHMOND
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State | VA
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Zip | 23222-2105
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Country | US
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Telephone | 804-625-4645
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | TYCHELLE BROWN
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Credential | LMHP-R
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Telephone | 804-625-1094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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