MEDICARE: PROSPERITY WELLNESS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1265288450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPERITY WELLNESS LLC

Provider Business Mailing Address
First Line	:	409 E LABURNUM AVE STE 5
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2105
Country	:	US
Telephone Number	:	804-625-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 E LABURNUM AVE STE 5
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2105
Country	:	US
Telephone Number	:	804-625-4645
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	TYCHELLE BROWN
Credential	:	LMHP-R
Telephone Number	:	804-625-1094

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	01/18/2026

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Directions to “PROSPERITY WELLNESS LLC ” Practice Location

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