Provider Demographics
NPI:1326651936
Name:WISE MIND SOLUTIONS, LLC
Entity Type:Organization
Organization Name:WISE MIND SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:FORTNEY
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-919-2021
Mailing Address - Street 1:2850 EISENHOWER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4567
Mailing Address - Country:US
Mailing Address - Phone:844-947-3326
Mailing Address - Fax:
Practice Address - Street 1:2850 EISENHOWER AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4567
Practice Address - Country:US
Practice Address - Phone:703-919-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health