Provider Demographics
NPI:1801041132
Name:VIGILANT MINDZ
Entity Type:Organization
Organization Name:VIGILANT MINDZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E,O
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:804-306-0163
Mailing Address - Street 1:9709 TARTUFFE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4930
Mailing Address - Country:US
Mailing Address - Phone:804-612-2994
Mailing Address - Fax:
Practice Address - Street 1:530 E MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2418
Practice Address - Country:US
Practice Address - Phone:804-612-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1152-02-029251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services