Organization
TO THE MOON PLLC
Active
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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