Provider Demographics
NPI:1215741004
Name:MIND OVER MAYHEM LLC
Entity type:Organization
Organization Name:MIND OVER MAYHEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-987-4323
Mailing Address - Street 1:8203 SPRING MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4672
Mailing Address - Country:US
Mailing Address - Phone:434-987-4323
Mailing Address - Fax:
Practice Address - Street 1:8203 SPRING MEADOW RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4672
Practice Address - Country:US
Practice Address - Phone:804-420-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30018130450001Medicaid