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NPI Code Detail

MEDICARE: REALIGN YOUR MIND COUNSELING SERVICES

MEDICARE: REALIGN YOUR MIND COUNSELING SERVICES
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1427638345
Entity Type Code : Organization
Provider Name (Legal Business Name) : REALIGN YOUR MIND COUNSELING SERVICES
Provider Business Mailing Address
First Line : 6372 MECHANICSVILLE TPKE STE 111
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23111-4705
Country : US
Telephone Number : 804-477-4808
Fax Number : 804-592-6971
Provider Business Practice Location Address
First Line : 6372 MECHANICSVILLE TPKE STE 111
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23111-4705
Country : US
Telephone Number : 804-477-4808
Fax Number : 804-592-6971
Authorized Official
Title or Position : LICENSED PROFESSIONAL COUNSELOR
Name : NICOLE HOLLER-BLACKMON
Credential : LPC
Telephone Number : 804-477-4808
Provider Enumeration Date : 04/13/2021
Last Update Date : 03/17/2026

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Directions to “REALIGN YOUR MIND COUNSELING SERVICES ” Practice Location

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