MEDICARE: THE NOVA WELLNESS GROUP, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205620267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NOVA WELLNESS GROUP, LLC.

Provider Business Mailing Address
First Line	:	8401 MAYLAND DR # 4685
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	804-854-5613
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 MAYLAND DR # 4685
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	804-854-5613
Fax Number	:

Authorized Official
Title or Position	:	OWNER PSYCHOTHERAPIST
Name	:	LATROYA TUCKER
Credential	:	LCSW
Telephone Number	:	804-854-5613

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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