1023675477 NPI number — HAPPY HEALTHY HEALING PLLC

Table of content: (NPI 1023675477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023675477 NPI number — HAPPY HEALTHY HEALING PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAPPY HEALTHY HEALING PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023675477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14808 MILLICENT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20120-1867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-405-7499
Provider Business Mailing Address Fax Number:
703-543-2639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5675 STONE RD.
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-405-7499
Provider Business Practice Location Address Fax Number:
703-543-2639
Provider Enumeration Date:
05/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMACK
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-405-7499

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0701007134 . This is a "LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3001745073001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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