# YOUR NURSE PRACTITIONER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Panacea Behavioral Health & Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801489711
- **Authorized official:** DR. SANDRA W NICHOLS PHD, APRN, PMHNP-BC (CEO)
- **Authorized official phone:** (757) 251-0879

## Contact information

- **Practice address:** 4360 SHORE DR STE 101, VIRGINIA BEACH, VA 23455-2994
- **Practice address phone:** (757) 251-0879
- **Practice address fax:** (984) 220-9437
- **Mailing address:** 4360 SHORE DR STE 101, VIRGINIA BEACH, VA 23455-2994
- **Mailing address phone:** (757) 251-0879
- **Mailing address fax:** (984) 220-9437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |
| 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