Healthcare Provider Details

I. General information

NPI: 1952987034
Provider Name (Legal Business Name): BODY AND MINDFULLY HEALTHY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CALHOUN ST
GALAX VA
24333-3806
US

IV. Provider business mailing address

PO BOX 1141
GALAX VA
24333-1141
US

V. Phone/Fax

Practice location:
  • Phone: 276-293-1235
  • Fax: 540-613-1831
Mailing address:
  • Phone: 276-601-2749
  • Fax: 540-613-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SUE ANN LONDRY
Title or Position: CEO / FOUNDER
Credential: LPC
Phone: 276-293-1235