Provider Demographics
NPI:1669341475
Name:EVERGREEN PSYCHIATRIC AND MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:EVERGREEN PSYCHIATRIC AND MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLATUNDE
Authorized Official - Middle Name:AKINNOLA
Authorized Official - Last Name:AKINFOLAJIMI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:804-647-3826
Mailing Address - Street 1:6404 GARDEN ACRE CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6534
Mailing Address - Country:US
Mailing Address - Phone:804-647-3826
Mailing Address - Fax:804-647-3826
Practice Address - Street 1:6404 GARDEN ACRE CT
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-6534
Practice Address - Country:US
Practice Address - Phone:804-647-3826
Practice Address - Fax:804-647-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty