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General NPI Number Information
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NPI Number | 1881566644
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Entity Type | Organization
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Legal Business Name | SOUND MIND AND BODY COLLECTIVE, PLLC
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 5104 YAWL CT.
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City | WOODBRIDGE
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State | VA
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Zip | 22193
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Country | US
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Telephone | 703-732-6149
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Fax |
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Provider Business Mailing Address
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Address Line | 5510 CHEROKEE AVE STE 300
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City | ALEXANDRIA
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State | VA
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Zip | 22312-2320
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Country | US
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Telephone | 703-732-6149
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | INGRID MADISON
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Credential | LCSW
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Telephone | 703-732-6149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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