# FAIRY THERAPETUIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MYSTIC FLOW WELLNESS CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194659631
- **Legal business name:** MYSTIC FLOW WELLNESS CENTER
- **Authorized official:** KASSI MOORE (RELAXATIONAL THERAIPST)
- **Authorized official phone:** (540) 571-1880

## Contact information

- **Practice address:** 6884 PIEDMONT CENTER PLZ, GAINESVILLE, VA 20155-4035
- **Practice address phone:** (571) 284-7612
- **Mailing address:** PO BOX 31, BEALETON, VA 22712-0031
- **Mailing address phone:** (540) 571-1880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 163WM1400X | Nurse Massage Therapist (NMT) | — | NULL | — |
| 163WM1400X | Nurse Massage Therapist (NMT) | — | — | — |
| 171000000X | Military Health Care Provider | — | NULL | — |
| 171000000X | Military Health Care Provider | — | — | — |
| 171400000X | Health & Wellness Coach | — | NULL | Yes |
| 171400000X | Health & Wellness Coach | — | — | Yes |
| 173C00000X | Reflexologist | — | NULL | — |
| 173C00000X | Reflexologist | — | — | — |
| 225700000X | Massage Therapist | — | NULL | — |
| 225700000X | Massage Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/10/2026
- **Last updated:** 06/10/2026