=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710448964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL AROUND ACHIEVERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2019
-----------------------------------------------------
Last Update Date | 03/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6941 FOX DR
-----------------------------------------------------
City | PRINCE GEORGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23875-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-301-5140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6941 FOX DR
-----------------------------------------------------
City | PRINCE GEORGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23875-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-301-5140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TYQUAN TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-301-5140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------