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General NPI Number Information
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NPI Number | 1558215467
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Entity Type | Organization
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Legal Business Name | PACIFIC MIND & WELLNESS PSYCHIATRIC CARE, PLLC
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 6196 BELAY DRIVE
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234
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Country | US
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Telephone | 804-404-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 13926 HULL STREET RD PO BOX 3013
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2004
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Country | US
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Telephone | 804-404-9276
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DESTINY RUSSELL GRAY
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Credential | APRN
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Telephone | 804-835-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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