| The Mind Health Center, Llc | |
|
5700 W Grace St Suite 105-a Richmond VA 23226-1832 | |
| (804) 442-3116 | |
| Not Available |
| Full Name | The Mind Health Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5700 W Grace St, Richmond, Virginia |
| Authorized Official Name and Position | Diane R Mattingly (OWNER) |
| Authorized Official Contact | 8044423116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Mind Health Center, Llc 5700 W Grace St Suite 105-a Richmond VA 23226-1832 Ph: (804) 442-3116 | The Mind Health Center, Llc 5700 W Grace St Suite 105-a Richmond VA 23226-1832 Ph: (804) 442-3116 |
| NPI Number | 1336699461 |
|---|---|
| Provider Enumeration Date | 10/13/2016 |
| Last Update Date | 11/30/2020 |
| Certification Date | 11/30/2020 |
| Medicare PECOS PAC ID | 8022429661 |
|---|---|
| Medicare Enrollment ID | O20201202003101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336699461 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904007756 (Virginia) | Primary |
| Provider Name | Jenny Warne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992183453 PECOS PAC ID: 0840570784 Enrollment ID: I20161209001685 |
| Provider Name | Luke Giannini |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396387858 PECOS PAC ID: 9931510575 Enrollment ID: I20201202003167 |
| Provider Name | Alexandria Wall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790354074 PECOS PAC ID: 6507264934 Enrollment ID: I20211014002597 |
| Provider Name | Melanie Renault |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669192092 PECOS PAC ID: 5597136192 Enrollment ID: I20230118001887 |
| Provider Name | Jessica Marie Evans |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437922838 PECOS PAC ID: 7113378233 Enrollment ID: I20240112001584 |
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