Healthcare Provider Details

I. General information

NPI: 1992621080
Provider Name (Legal Business Name): JOURNEY TO EMPOWERED MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12025 ALMER LN
CHESTER VA
23836-3081
US

IV. Provider business mailing address

12025 ALMER LN
CHESTER VA
23836-3081
US

V. Phone/Fax

Practice location:
  • Phone: 912-755-9466
  • Fax: 912-755-9466
Mailing address:
  • Phone: 912-755-9466
  • Fax: 912-755-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHINEICE COLEMAN
Title or Position: OWNER
Credential:
Phone: 912-755-9466