Provider Demographics
NPI:1013580992
Name:NGU, MINDY TRAN (QMHP-A - RIC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:TRAN
Last Name:NGU
Suffix:
Gender:F
Credentials:QMHP-A - RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7134
Mailing Address - Country:US
Mailing Address - Phone:540-621-1183
Mailing Address - Fax:
Practice Address - Street 1:4024 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4800
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:877-282-3019
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704006353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health