Healthcare Provider Details

I. General information

NPI: 1891470670
Provider Name (Legal Business Name): GRATEFUL MIND MENTAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 CROSSWAYS BLVD STE 250
CHESAPEAKE VA
23320-0218
US

IV. Provider business mailing address

1545 CROSSWAYS BLVD STE 250
CHESAPEAKE VA
23320-0218
US

V. Phone/Fax

Practice location:
  • Phone: 757-541-8390
  • Fax:
Mailing address:
  • Phone: 757-541-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA BOWEN
Title or Position: OWNER
Credential: PMHNP
Phone: 757-541-8390