Healthcare Provider Details

I. General information

NPI: 1396548921
Provider Name (Legal Business Name): SUBLIME MIND, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 FIRST COLONIAL RD STE 100
VIRGINIA BEACH VA
23454-3111
US

IV. Provider business mailing address

104 MARINERS CT
SMITHFIELD VA
23430-5630
US

V. Phone/Fax

Practice location:
  • Phone: 757-280-4801
  • Fax: 757-767-7866
Mailing address:
  • Phone: 757-280-4801
  • Fax: 757-767-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMM HALL
Title or Position: BILLER
Credential:
Phone: 813-395-9269