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General NPI Number Information
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NPI Number | 1255595104
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND THERAPIES, LLC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 723 PINEY FOREST RD
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City | DANVILLE
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State | VA
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Zip | 24540-2860
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Country | US
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Telephone | 434-836-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 218 FORESTROAD DR
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City | DANVILLE
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State | VA
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Zip | 24540-6102
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Country | US
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Telephone | 434-836-0758
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BLANCHE M WILLIAMS
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Credential | PH.D.
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Telephone | 434-836-0758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002840
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License Number State | VA
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