| Mind Revolution Services Llc | |
|
1800 E Main St Richmond VA 23223-6962 | |
| (703) 628-0705 | |
| Not Available |
| Full Name | Mind Revolution Services Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1800 E Main St, Richmond, Virginia |
| Authorized Official Name and Position | Tysean Markeal Ford (PRESIDENT) |
| Authorized Official Contact | 7036280705 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Revolution Services Llc 1800 E Main St Richmond VA 23223-6962 Ph: (703) 628-0705 | Mind Revolution Services Llc 1800 E Main St Richmond VA 23223-6962 Ph: (703) 628-0705 |
| NPI Number | 1801571872 |
|---|---|
| Provider Enumeration Date | 06/19/2023 |
| Last Update Date | 06/21/2023 |
| Certification Date | 06/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801571872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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