Organization
TO THE MOON PLLC
Active
Other names
To the Moon ABA Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
LIZNA KHIMANI MA (BCBA)
(804) 728-8827
Entity
Organization
Contact information
Practice address
10307 PEBBLEBROOK PL, RICHMOND, VA 23238-6807
(804) 728-8882
Mailing address
14497 POTOMAC MILLS RD # 1013, WOODBRIDGE, VA 22192-6807
(804) 728-8882
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
03/02/2022
Last updated
12/10/2024
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