Provider Demographics
NPI:1477178218
Name:PEACE OF MIND THERAPEUTIC SOLUTIONS
Entity Type:Organization
Organization Name:PEACE OF MIND THERAPEUTIC SOLUTIONS
Other - Org Name:PEACE OF MIND THERAPEUTIC SOLUTIONS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-966-1270
Mailing Address - Street 1:355 CRAWFORD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2817
Mailing Address - Country:US
Mailing Address - Phone:757-966-1270
Mailing Address - Fax:757-966-2967
Practice Address - Street 1:355 CRAWFORD ST STE 102
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2817
Practice Address - Country:US
Practice Address - Phone:757-966-1270
Practice Address - Fax:757-966-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598219214Medicaid
VA1598219214Medicaid