| Mindful Innovations Llc | |
|
106 Vista Heights Dr Ruckersville VA 22968-9510 | |
| (804) 723-6463 | |
| Not Available |
| Full Name | Mindful Innovations Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 106 Vista Heights Dr, Ruckersville, Virginia |
| Authorized Official Name and Position | William Ryan Mccoull (OWNER) |
| Authorized Official Contact | 8049206450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Innovations Llc 106 Vista Heights Dr Ruckersville VA 22968-9510 Ph: (804) 723-6463 | Mindful Innovations Llc 106 Vista Heights Dr Ruckersville VA 22968-9510 Ph: (804) 723-6463 |
| NPI Number | 1194422907 |
|---|---|
| Provider Enumeration Date | 02/13/2023 |
| Last Update Date | 06/23/2024 |
| Certification Date | 06/23/2024 |
| Medicare PECOS PAC ID | 6305387499 |
|---|---|
| Medicare Enrollment ID | O20240917000477 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194422907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Emily Frances Kerschen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932821667 PECOS PAC ID: 4587040993 Enrollment ID: I20221007000422 |
| Provider Name | Ashli Gregory |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154922342 PECOS PAC ID: 3577004662 Enrollment ID: I20240917000740 |
| Provider Name | William Ryan Mccoull |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235607540 PECOS PAC ID: 2668913757 Enrollment ID: I20241002002061 |
Life Works Professional Counseling, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 8767 Seminole Trl Ste 101, Ruckersville, VA 22968 Phone: 434-990-1744 Fax: 434-939-9401 | |