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Organization
MIND REVOLUTION SERVICES LLC
Active
Organization
MIND REVOLUTION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYSEAN MARKEAL FORD (PRESIDENT)
(703) 628-0705
Entity
Organization
Contact information
Practice address
1800 E MAIN ST, RICHMOND, VA 23223-6962
(703) 628-0705
Mailing address
1800 E MAIN ST, RICHMOND, VA 23223-6962
(703) 628-0705
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/19/2023
Last updated
06/21/2023
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