Healthcare Provider Details

I. General information

NPI: 1851218754
Provider Name (Legal Business Name): RITTER MINNIX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 SANFORD AVE SW
ROANOKE VA
24014-1123
US

IV. Provider business mailing address

2545 SANFORD AVE SW
ROANOKE VA
24014-1123
US

V. Phone/Fax

Practice location:
  • Phone: 540-258-4065
  • Fax:
Mailing address:
  • Phone: 540-258-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717002692
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: