Provider Demographics
NPI:1972146223
Name:NOVA HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:NOVA HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHIDHRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:804-601-0042
Mailing Address - Street 1:13305 OLD BARN CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4874
Mailing Address - Country:US
Mailing Address - Phone:804-601-0042
Mailing Address - Fax:804-706-1640
Practice Address - Street 1:13305 OLD BARN CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4874
Practice Address - Country:US
Practice Address - Phone:804-601-0042
Practice Address - Fax:804-706-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty