Provider Demographics
NPI:1558067272
Name:MENTAL BALANCE AND HEALING
Entity type:Organization
Organization Name:MENTAL BALANCE AND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-396-4106
Mailing Address - Street 1:4907 FITZHUGH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3533
Mailing Address - Country:US
Mailing Address - Phone:804-396-4106
Mailing Address - Fax:804-358-0034
Practice Address - Street 1:4907 FITZHUGH AVE STE 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3533
Practice Address - Country:US
Practice Address - Phone:804-396-4106
Practice Address - Fax:804-358-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017443320001Medicaid