Provider Demographics
NPI:1427638345
Name:REALIGN YOUR MIND COUNSELING SERVICES
Entity type:Organization
Organization Name:REALIGN YOUR MIND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLER-BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-477-4808
Mailing Address - Street 1:6372 MECHANICSVILLE TPKE STE 111
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-477-4808
Mailing Address - Fax:804-592-6971
Practice Address - Street 1:6372 MECHANICSVILLE TPKE STE 111
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4705
Practice Address - Country:US
Practice Address - Phone:804-477-4808
Practice Address - Fax:804-592-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty