Provider Demographics
NPI:1821644840
Name:SIMPLY MINDFUL SOLUTIONS
Entity Type:Organization
Organization Name:SIMPLY MINDFUL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-675-5415
Mailing Address - Street 1:5020 PHEASANT RIDGE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6215
Mailing Address - Country:US
Mailing Address - Phone:703-675-5415
Mailing Address - Fax:
Practice Address - Street 1:10650 MAIN ST STE 101A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3814
Practice Address - Country:US
Practice Address - Phone:703-675-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health