Provider Demographics
NPI:1336699461
Name:THE MIND HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:THE MIND HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-442-3116
Mailing Address - Street 1:5700 W GRACE ST
Mailing Address - Street 2:SUITE 105-A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1832
Mailing Address - Country:US
Mailing Address - Phone:804-442-3116
Mailing Address - Fax:
Practice Address - Street 1:5700 W GRACE ST
Practice Address - Street 2:SUITE 105-A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1832
Practice Address - Country:US
Practice Address - Phone:804-442-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty