Provider Demographics
NPI:1649015876
Name:STILL MIND LLC
Entity type:Organization
Organization Name:STILL MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMAECHI
Authorized Official - Middle Name:FIDELIA
Authorized Official - Last Name:EGBUJUO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:772-607-0782
Mailing Address - Street 1:3730 CANDLERS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2240
Mailing Address - Country:US
Mailing Address - Phone:434-233-0328
Mailing Address - Fax:
Practice Address - Street 1:3730 CANDLERS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2240
Practice Address - Country:US
Practice Address - Phone:434-233-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty