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General NPI Number Information
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NPI Number | 1962861641
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Entity Type | Organization
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Legal Business Name | VIGILANT MINDZ
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 1801 E BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23223-6974
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Country | US
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Telephone | 804-306-0163
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 945
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City | RICHMOND
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State | VA
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Zip | 23218-0945
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Country | US
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Telephone | 804-306-0163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWN LAMONT MINTER
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Credential | BSW, QMHP
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Telephone | 804-306-0163
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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 | 1152
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License Number State | VA
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