MEDICARE: BEACON MENTAL HEALTH AND WELLNESS PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1265398812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON MENTAL HEALTH AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	6601 AUTUMN MIST WAY
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-8490
Country	:	US
Telephone Number	:	686-202-4641
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 E LABURNUM AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2210
Country	:	US
Telephone Number	:	686-202-4641
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	TOLA OLUWAFUNKE AKINBOBOLA
Credential	:	PMHNP
Telephone Number	:	686-202-4641

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	01/09/2026

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