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General NPI Number Information
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NPI Number | 1760201057
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Entity Type | Organization
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Legal Business Name | MINDFUL SOLUTION SERVICES
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 31 N PROVIDENCE RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5221
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Country | US
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Telephone | 804-601-8553
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Fax | 804-902-1099
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Provider Business Mailing Address
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Address Line | 31 N PROVIDENCE RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5221
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Country | US
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Telephone | 804-601-8553
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Fax | 804-902-1099
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | CANDICE SHIN
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Credential | LCSW
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Telephone | 804-904-9429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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