Healthcare Provider Details

I. General information

NPI: 1124958301
Provider Name (Legal Business Name): MIND AND WELLNESS COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 LOWRY RD STE S
COLUMBIA VA
23038-2104
US

IV. Provider business mailing address

8401 MAYLAND DR STE S
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 804-409-0686
  • Fax:
Mailing address:
  • Phone: 804-409-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELSEY MCCRANN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 804-409-0686