Healthcare Provider Details

I. General information

NPI: 1952812810
Provider Name (Legal Business Name): SUCCESS IN MIND OF VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NEW POINT RD STE 3202
WILLIAMSBURG VA
23188-9423
US

IV. Provider business mailing address

5000 NEW POINT RD STE 3202
WILLIAMSBURG VA
23188-9423
US

V. Phone/Fax

Practice location:
  • Phone: 757-903-2253
  • Fax: 757-914-1461
Mailing address:
  • Phone: 757-903-2253
  • Fax: 757-903-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS ALLEN BROWN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 757-645-3558