Provider Demographics
NPI:1891317269
Name:PADME WELLNESS, LLC
Entity Type:Organization
Organization Name:PADME WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LUISIANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSATP
Authorized Official - Phone:804-506-3849
Mailing Address - Street 1:704 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1310
Mailing Address - Country:US
Mailing Address - Phone:804-506-3849
Mailing Address - Fax:804-508-6312
Practice Address - Street 1:17 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2109
Practice Address - Country:US
Practice Address - Phone:804-506-3849
Practice Address - Fax:804-508-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336293000Medicaid