Healthcare Provider Details

I. General information

NPI: 1063058022
Provider Name (Legal Business Name): A BETTER MIND, A BETTER ME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

IV. Provider business mailing address

2308 MOUNT VERNON AVE STE 448
ALEXANDRIA VA
22301-1328
US

V. Phone/Fax

Practice location:
  • Phone: 703-718-5937
  • Fax:
Mailing address:
  • Phone: 703-718-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DARA GRIMES
Title or Position: OWNER
Credential: LCSW
Phone: 818-599-5774