Provider Demographics
NPI:1073323937
Name:NOURISHING MINDS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:NOURISHING MINDS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CICELY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-943-1713
Mailing Address - Street 1:20201 SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23803-1635
Mailing Address - Country:US
Mailing Address - Phone:804-943-1713
Mailing Address - Fax:
Practice Address - Street 1:20713 BESSIE LN
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-1617
Practice Address - Country:US
Practice Address - Phone:804-943-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health