Provider Demographics
NPI:1477309086
Name:ASPIRING MINDS WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ASPIRING MINDS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KENATTA
Authorized Official - Middle Name:AMOURE
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:757-839-8500
Mailing Address - Street 1:500 E MAIN ST STE 1600-150
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2205
Mailing Address - Country:US
Mailing Address - Phone:757-839-8500
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST STE 1600-150
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2205
Practice Address - Country:US
Practice Address - Phone:757-839-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty