Healthcare Provider Details

I. General information

NPI: 1295377323
Provider Name (Legal Business Name): ENHANCING MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W WASHINGTON ST STE 504
SUFFOLK VA
23434-5246
US

IV. Provider business mailing address

112 W WASHINGTON ST STE 504
SUFFOLK VA
23434-5246
US

V. Phone/Fax

Practice location:
  • Phone: 757-281-8366
  • Fax:
Mailing address:
  • Phone: 757-281-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE GODWIN
Title or Position: CEO
Credential: QMHP
Phone: 757-281-8366