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General NPI Number Information
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NPI Number | 1124883434
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Entity Type | Organization
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Legal Business Name | MINDS THAT MATTER LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 808 EDEN WAY N
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0745
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Country | US
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Telephone | 757-354-3161
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 CRYSTAL LAKE DR
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3624
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Country | US
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Telephone | 757-531-6485
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | STACIE ANITA PITTMAN
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Credential |
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Telephone | 757-531-6485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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