Healthcare Provider Details

I. General information

NPI: 1760201057
Provider Name (Legal Business Name): MINDFUL SOLUTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N PROVIDENCE RD
NORTH CHESTERFIELD VA
23235-5221
US

IV. Provider business mailing address

31 N PROVIDENCE RD
NORTH CHESTERFIELD VA
23235-5221
US

V. Phone/Fax

Practice location:
  • Phone: 804-601-8553
  • Fax: 804-902-1099
Mailing address:
  • Phone: 804-601-8553
  • Fax: 804-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CANDICE SHIN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 804-904-9429