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General NPI Number Information
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NPI Number | 1427794106
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Entity Type | Organization
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Legal Business Name | MIND MD
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 15221 CARROLLTON BLVD STE 102
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City | CARROLLTON
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State | VA
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Zip | 23314-2325
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Country | US
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Telephone | 757-922-3085
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Fax | 866-362-7725
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Provider Business Mailing Address
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Address Line | PO BOX 1292
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City | YORKTOWN
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State | VA
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Zip | 23692-1292
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATION/BUSINESS MANAGER
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Name | CORRINA CAGLE
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Credential |
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Telephone | 315-283-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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