Organization
VIGILANT MINDZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN LAMONT MINTER BSW, QMHP (OWNER)
(804) 306-0163
Entity
Organization
Contact information
Practice address
1801 E BROAD ST, RICHMOND, VA 23223-6974
(804) 306-0163
Mailing address
PO BOX 945, RICHMOND, VA 23218-0945
(804) 306-0163
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1152
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801041132
—
VA
Enumeration date
02/23/2016
Last updated
02/23/2016
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