# MIRACLE MILES MENTAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700600665
- **Authorized official:** TONJANIKA BALLARD (BUSINESS CONSULTANT)
- **Authorized official phone:** (804) 441-8538

## Contact information

- **Practice address:** 5841 SNEAD RD, RICHMOND, VA 23224-4661
- **Practice address phone:** (804) 688-9777
- **Mailing address:** 5841 SNEAD RD, RICHMOND, VA 23224-4661
- **Mailing address phone:** (804) 688-9777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2024
- **Last updated:** 11/08/2024