Healthcare Provider Details

I. General information

NPI: 1285130633
Provider Name (Legal Business Name): MYND MATTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 ARBORETUM PKWY STE 110
NORTH CHESTERFIELD VA
23236-5403
US

IV. Provider business mailing address

9201 ARBORETUM PKWY STE 110
NORTH CHESTERFIELD VA
23236-5403
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-0101
  • Fax: 804-320-0808
Mailing address:
  • Phone: 804-320-0101
  • Fax: 804-320-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID DAMERON
Title or Position: OWNER
Credential: PHD
Phone: 804-320-0101