Organization
PERSIMMON GROVE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELICA HARDIANTO LPC (PRACTICE OWNER)
(804) 215-6315
Entity
Organization
Contact information
Practice address
1904 BYRD AVE STE 325, RICHMOND, VA 23230-3029
(804) 215-6315
Mailing address
11357 NUCKOLS RD # 2205, GLEN ALLEN, VA 23059-5504
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/03/2025
Last updated
12/03/2025
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