Healthcare Provider Details

I. General information

NPI: 1639821572
Provider Name (Legal Business Name): ECCENTRIC MINDS HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 VALLEY ST BLDG 6M
PROVIDENCE RI
02909-2400
US

IV. Provider business mailing address

735 THIMBLE SHOALS BLVD STE 130
NEWPORT NEWS VA
23606-4428
US

V. Phone/Fax

Practice location:
  • Phone: 401-682-7382
  • Fax: 401-210-3750
Mailing address:
  • Phone: 757-333-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NADIA DOTRICE HORTON
Title or Position: OWNER
Credential:
Phone: 757-333-0175