Healthcare Provider Details

I. General information

NPI: 1336699461
Provider Name (Legal Business Name): THE MIND HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 STAPLES MILL RD STE 200
HENRICO VA
23228-5445
US

IV. Provider business mailing address

5511 STAPLES MILL RD STE 200
HENRICO VA
23228-5445
US

V. Phone/Fax

Practice location:
  • Phone: 804-442-3116
  • Fax: 804-442-3116
Mailing address:
  • Phone: 804-442-3116
  • Fax: 804-442-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007756
License Number StateVA

VIII. Authorized Official

Name: LUKE GIANNINI
Title or Position: OWNER
Credential: LCSW
Phone: 804-442-3116