Provider Demographics
NPI:1194404442
Name:CHANGING MINDS PEDIATRIC & ADOLESCENT PSYCHIATRY
Entity type:Organization
Organization Name:CHANGING MINDS PEDIATRIC & ADOLESCENT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRECENGOST
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:804-814-0107
Mailing Address - Street 1:11357 NUCKOLS RD # 1333
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6386 LITTLE SORREL DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4480
Practice Address - Country:US
Practice Address - Phone:804-814-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health