Healthcare Provider Details

I. General information

NPI: 1124883434
Provider Name (Legal Business Name): MINDS THAT MATTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 EDEN WAY N
CHESAPEAKE VA
23320-0745
US

IV. Provider business mailing address

1580 CRYSTAL LAKE DR
PORTSMOUTH VA
23701-3624
US

V. Phone/Fax

Practice location:
  • Phone: 757-354-3161
  • Fax:
Mailing address:
  • Phone: 757-531-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STACIE ANITA PITTMAN
Title or Position: PMHNP-BC
Credential:
Phone: 757-531-6485