Provider Demographics
NPI:1194404566
Name:MINDFUL SOLUTIONS CLINICAL & CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:MINDFUL SOLUTIONS CLINICAL & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALETA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-721-9715
Mailing Address - Street 1:208 N 2ND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2703
Mailing Address - Country:US
Mailing Address - Phone:804-293-0261
Mailing Address - Fax:
Practice Address - Street 1:208 N 2ND AVE STE 2
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2703
Practice Address - Country:US
Practice Address - Phone:804-293-0261
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?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty