Provider Demographics
NPI:1629843719
Name:HEALING FOR ADVANCEMENT LLC
Entity Type:Organization
Organization Name:HEALING FOR ADVANCEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-895-8450
Mailing Address - Street 1:4603 BRICKWOOD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-8875
Mailing Address - Country:US
Mailing Address - Phone:804-895-8450
Mailing Address - Fax:
Practice Address - Street 1:4603 BRICKWOOD MEADOW DR
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-8875
Practice Address - Country:US
Practice Address - Phone:804-895-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty