Provider Demographics
NPI:1972268043
Name:I AM A MIND HEALER WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:I AM A MIND HEALER WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-867-2565
Mailing Address - Street 1:2769 JEFFERSON DAVIS HWY STE 111-1098
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8325
Mailing Address - Country:US
Mailing Address - Phone:540-300-5289
Mailing Address - Fax:
Practice Address - Street 1:1 DEMOCRACY CIR APT 204
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8147
Practice Address - Country:US
Practice Address - Phone:540-300-5289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty