Healthcare Provider Details

I. General information

NPI: 1801351663
Provider Name (Legal Business Name): MIND OVER MATTER THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S INDEPENDENCE BLVD STE 207
VIRGINIA BEACH VA
23452-1150
US

IV. Provider business mailing address

1729 ROWLOCK RD
CHESAPEAKE VA
23321-3316
US

V. Phone/Fax

Practice location:
  • Phone: 757-652-7213
  • Fax: 757-818-9781
Mailing address:
  • Phone: 757-333-2131
  • Fax: 757-818-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAURA HOBSON
Title or Position: LPC
Credential:
Phone: 757-333-2131