Provider Demographics
NPI:1952812810
Name:SUCCESS IN MIND OF VIRGINIA LLC
Entity Type:Organization
Organization Name:SUCCESS IN MIND OF VIRGINIA LLC
Other - Org Name:SUCCESS BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-645-3558
Mailing Address - Street 1:5000 NEW POINT RD STE 3202
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-9423
Mailing Address - Country:US
Mailing Address - Phone:757-903-2253
Mailing Address - Fax:757-903-2293
Practice Address - Street 1:5000 NEW POINT RD STE 3202
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-9423
Practice Address - Country:US
Practice Address - Phone:757-903-2253
Practice Address - Fax:757-914-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty