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General NPI Number Information
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NPI Number | 1427638345
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Entity Type | Organization
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Legal Business Name | REALIGN YOUR MIND COUNSELING SERVICES
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 6372 MECHANICSVILLE TPKE STE 111
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-4705
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Country | US
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Telephone | 804-477-4808
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Fax | 804-592-6971
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Provider Business Mailing Address
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Address Line | 6372 MECHANICSVILLE TPKE STE 111
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-4705
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Country | US
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Telephone | 804-477-4808
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Fax | 804-592-6971
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | NICOLE HOLLER-BLACKMON
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Credential | LPC
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Telephone | 804-477-4808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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