Healthcare Provider Details

I. General information

NPI: 1790477750
Provider Name (Legal Business Name): SOUND MIND RESTORATION AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11828 CANON BLVD STE H
NEWPORT NEWS VA
23606-2554
US

IV. Provider business mailing address

11828 CANON BLVD STE H
NEWPORT NEWS VA
23606-2554
US

V. Phone/Fax

Practice location:
  • Phone: 804-933-6500
  • Fax:
Mailing address:
  • Phone: 804-933-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATOYA RENEE NTLABATI
Title or Position: OWNER
Credential: PMHNP
Phone: 804-525-6448