Organization
MIND MD
Active
Other names
Lotus Health PC
Organization subpart
No
Provider details
NPI number
Authorized official
CORRINA CAGLE (OPERATION/BUSINESS MANAGER)
(315) 283-1468
Entity
Organization
Contact information
Practice address
15221 CARROLLTON BLVD STE 102, CARROLLTON, VA 23314-2325
(757) 922-3085
(866) 362-7725
Mailing address
PO BOX 1292, YORKTOWN, VA 23692-1292
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11375291
COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION
VA
Enumeration date
05/06/2022
Last updated
05/06/2022
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