Provider Demographics
NPI:1518690411
Name:ADDY'S COLORS
Entity Type:Organization
Organization Name:ADDY'S COLORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-725-8597
Mailing Address - Street 1:2358 WAKE RD
Mailing Address - Street 2:
Mailing Address - City:WAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23176-2120
Mailing Address - Country:US
Mailing Address - Phone:804-725-8597
Mailing Address - Fax:
Practice Address - Street 1:2358 WAKE RD
Practice Address - Street 2:
Practice Address - City:WAKE
Practice Address - State:VA
Practice Address - Zip Code:23176-2120
Practice Address - Country:US
Practice Address - Phone:804-725-8597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty