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General NPI Number Information
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NPI Number | 1821644840
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Entity Type | Organization
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Legal Business Name | SIMPLY MINDFUL SOLUTIONS
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 10650 MAIN ST STE 101A
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City | FAIRFAX
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State | VA
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Zip | 22030-3814
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Country | US
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Telephone | 703-675-5415
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Fax |
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Provider Business Mailing Address
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Address Line | 5020 PHEASANT RIDGE RD STE 303
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City | FAIRFAX
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State | VA
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Zip | 22030-6215
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Country | US
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Telephone | 703-675-5415
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | INDIA W WALSH
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Credential | LCSW
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Telephone | 703-675-5415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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