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General NPI Number Information
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NPI Number | 1790477750
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Entity Type | Organization
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Legal Business Name | SOUND MIND RESTORATION AND WELLNESS CENTER
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 11828 CANON BLVD STE H
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2554
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Country | US
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Telephone | 804-933-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 11828 CANON BLVD STE H
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2554
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Country | US
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Telephone | 804-933-6500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATOYA RENEE NTLABATI
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Credential | PMHNP
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Telephone | 804-525-6448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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