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Organization
YOUR NURSE PRACTITIONER PLLC
Active
Organization
YOUR NURSE PRACTITIONER PLLC
Active
Other names
Panacea Behavioral Health & Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDRA W NICHOLS PHD, APRN, PMHNP-BC (CEO)
(757) 251-0879
Entity
Organization
Contact information
Practice address
4360 SHORE DR STE 101, VIRGINIA BEACH, VA 23455-2994
(757) 251-0879
(984) 220-9437
Mailing address
4360 SHORE DR STE 101, VIRGINIA BEACH, VA 23455-2994
(757) 251-0879
(984) 220-9437
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
225XH1300X
Human Factors Occupational Therapist
—
NULL
225XH1300X
Human Factors Occupational Therapist
—
—
225XM0800X
Mental Health Occupational Therapist
—
NULL
225XM0800X
Mental Health Occupational Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/11/2021
Last updated
01/16/2026
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