Healthcare Provider Details

I. General information

NPI: 1114822210
Provider Name (Legal Business Name): INSIGHTFUL IMPACT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 GRANT AVE
PETERSBURG VA
23803-5524
US

IV. Provider business mailing address

1300 GRANT AVE
PETERSBURG VA
23803-5524
US

V. Phone/Fax

Practice location:
  • Phone: 804-368-5537
  • Fax:
Mailing address:
  • Phone: 804-368-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. NIKITA BANKS JOHNSON
Title or Position: AUTHORIZED OFFICIAL / OWNER
Credential:
Phone: 804-368-5537