Healthcare Provider Details

I. General information

NPI: 1992503544
Provider Name (Legal Business Name): MINDCARE SOLUTIONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 PHEASANT RIDGE RD
ROANOKE VA
24014-5276
US

IV. Provider business mailing address

3102 W END AVE STE 1150
NASHVILLE TN
37203-1614
US

V. Phone/Fax

Practice location:
  • Phone: 330-319-4240
  • Fax:
Mailing address:
  • Phone: 330-319-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN NICHOLS
Title or Position: SR VP OF REVENUE OPERATIONS
Credential:
Phone: 330-319-4240