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General NPI Number Information
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NPI Number | 1912509282
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Entity Type | Organization
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Legal Business Name | REAL HEALING CENTER LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 916 N ARTHUR ASHE BLVD
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City | RICHMOND
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State | VA
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Zip | 23230-4802
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Country | US
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Telephone | 804-914-2169
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 BRIMLEY PL
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-5301
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Country | US
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Telephone | 804-914-2169
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KHADIJAH WASHINGTON
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Credential | LCSW
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Telephone | 804-914-2169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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