Provider Demographics
NPI:1427773308
Name:TRANSFORMING MINDS INTERVENTIONAL PSYCHIATRY
Entity type:Organization
Organization Name:TRANSFORMING MINDS INTERVENTIONAL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:757-908-2124
Mailing Address - Street 1:200 CARMICHAEL WAY STE 604
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2489
Mailing Address - Country:US
Mailing Address - Phone:757-908-2124
Mailing Address - Fax:757-908-2320
Practice Address - Street 1:200 CARMICHAEL WAY STE 604
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2489
Practice Address - Country:US
Practice Address - Phone:757-908-2124
Practice Address - Fax:757-908-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty