Healthcare Provider Details

I. General information

NPI: 1447833108
Provider Name (Legal Business Name): MINDFUL WELLNESS VI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11A NORRE GADE, SUITE 2 SUITE 4
ST THOMAS VI
00802-0080
US

IV. Provider business mailing address

5043 NORRE GADE STE 2
ST THOMAS VI
00802-6834
US

V. Phone/Fax

Practice location:
  • Phone: 340-201-1195
  • Fax:
Mailing address:
  • Phone: 340-201-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEIRDRE ANN WEST ROY
Title or Position: OWNER
Credential: LCSW
Phone: 340-201-1195