Provider Demographics
NPI:1679263453
Name:HEALTHY MINDS SUPPORTIVE INTERVENTIONS
Entity type:Organization
Organization Name:HEALTHY MINDS SUPPORTIVE INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIAJAH
Authorized Official - Middle Name:AISHAH
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP-A/C
Authorized Official - Phone:434-294-5601
Mailing Address - Street 1:115 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4279
Mailing Address - Country:US
Mailing Address - Phone:434-294-5601
Mailing Address - Fax:804-722-4001
Practice Address - Street 1:115 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4279
Practice Address - Country:US
Practice Address - Phone:434-294-5601
Practice Address - Fax:804-722-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty