=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669341475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERGREEN PSYCHIATRIC AND MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6404 GARDEN ACRE CT
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23111-6534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-647-3826
-----------------------------------------------------
Fax | 804-647-3826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6404 GARDEN ACRE CT
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23111-6534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-647-3826
-----------------------------------------------------
Fax | 804-647-3826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. OLATUNDE AKINNOLA AKINFOLAJIMI
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 804-647-3826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------