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General NPI Number Information
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NPI Number | 1891317269
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Entity Type | Organization
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Legal Business Name | PADME WELLNESS, LLC
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 17 E MAIN ST
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City | RICHMOND
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State | VA
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Zip | 23219-2109
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Country | US
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Telephone | 804-506-3849
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Fax | 804-508-6312
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Provider Business Mailing Address
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Address Line | 704 N 1ST ST
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City | RICHMOND
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State | VA
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Zip | 23219-1310
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Country | US
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Telephone | 804-506-3849
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Fax | 804-508-6312
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | LUISIANA I CANO
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Credential | LPC, LSATP
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Telephone | 804-506-3849
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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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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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