MEDICARE: GUIDING YOUNG MINDS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710218482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING YOUNG MINDS

Provider Business Mailing Address
First Line	:	1308 HAWK NEST WAY
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451
Country	:	US
Telephone Number	:	757-329-3268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 HAWK NEST WAY
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451
Country	:	US
Telephone Number	:	757-329-3268
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. NADINE DOMOND
Credential	:
Telephone Number	:	757-329-3268

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	01/20/2010

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