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General NPI Number Information
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NPI Number | 1639821572
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Entity Type | Organization
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Legal Business Name | ECCENTRIC MINDS HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 166 VALLEY ST BLDG 6M
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City | PROVIDENCE
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State | RI
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Zip | 02909-2400
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Country | US
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Telephone | 401-682-7382
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Fax | 401-210-3750
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Provider Business Mailing Address
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Address Line | 735 THIMBLE SHOALS BLVD STE 130
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4428
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Country | US
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Telephone | 757-333-0175
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NADIA DOTRICE HORTON
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Credential |
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Telephone | 757-333-0175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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