Provider Demographics
NPI:1790477750
Name:SOUND MIND RESTORATION AND WELLNESS CENTER
Entity type:Organization
Organization Name:SOUND MIND RESTORATION AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:NTLABATI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:804-525-6448
Mailing Address - Street 1:11828 CANON BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2554
Mailing Address - Country:US
Mailing Address - Phone:804-933-6500
Mailing Address - Fax:
Practice Address - Street 1:11828 CANON BLVD STE H
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2554
Practice Address - Country:US
Practice Address - Phone:804-933-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health