=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558224014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL MENTAL HEALTH AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9198 MARY BALL RD
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22503-2243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-294-0555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 112
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22503-0112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-294-0555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENYA MOODY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 804-294-0555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------