Provider Demographics
NPI:1679282917
Name:MINES, DEBORAH SAMANTHA
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SAMANTHA
Last Name:MINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 PINEHURST RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5035
Mailing Address - Country:US
Mailing Address - Phone:804-986-6058
Mailing Address - Fax:
Practice Address - Street 1:2921 PINEHURST RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5035
Practice Address - Country:US
Practice Address - Phone:804-986-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty