Provider Demographics
NPI:1194106112
Name:LOISELLE, MINDY (MSW)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LOISELLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 MONUMENT AVE
Mailing Address - Street 2:301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-2943
Mailing Address - Country:US
Mailing Address - Phone:804-562-6604
Mailing Address - Fax:804-308-0551
Practice Address - Street 1:1617 MONUMENT AVE STE 301
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-2943
Practice Address - Country:US
Practice Address - Phone:804-562-6604
Practice Address - Fax:804-308-0551
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040004251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical