MEDICARE: MINDFUL ASCENT PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235097213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL ASCENT PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	2716 BERNADOTTE ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-6518
Country	:	US
Telephone Number	:	757-232-9842
Fax Number	:	757-689-8715

Provider Business Practice Location Address
First Line	:	1248 GUNN HALL DR STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5757
Country	:	US
Telephone Number	:	757-339-6035
Fax Number	:	757-689-8715

Authorized Official
Title or Position	:	OWNER
Name	:	MARGRETTA F AUSTIN
Credential	:	LCSW DSW
Telephone Number	:	757-232-9842

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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