Healthcare Provider Details

I. General information

NPI: 1356146088
Provider Name (Legal Business Name): MIND MEND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 PORTER ST UNIT B
RICHMOND VA
23224-2068
US

IV. Provider business mailing address

1508 PORTER ST UNIT B
RICHMOND VA
23224-2068
US

V. Phone/Fax

Practice location:
  • Phone: 804-406-9036
  • Fax:
Mailing address:
  • Phone: 804-406-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY DALTON
Title or Position: PRACTICE OWNER
Credential: LCSW, LICSW, ESQ.
Phone: 804-406-9036