Healthcare Provider Details

I. General information

NPI: 1083424261
Provider Name (Legal Business Name): GREAT MINDS PSYCHIATRY AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 IRON BRIDGE RD STE C
CHESTER VA
23831-1428
US

IV. Provider business mailing address

8942 QUIOCCASIN RD
HENRICO VA
23229-5534
US

V. Phone/Fax

Practice location:
  • Phone: 804-295-4344
  • Fax: 804-509-0520
Mailing address:
  • Phone: 804-295-4344
  • Fax: 804-509-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY DANIELS
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 502-956-4213