Provider Demographics
NPI:1043505530
Name:A PEACE OF MIND COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:A PEACE OF MIND COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:804-677-6958
Mailing Address - Street 1:7316 JACKSON ARCH DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4721
Mailing Address - Country:US
Mailing Address - Phone:804-677-6958
Mailing Address - Fax:
Practice Address - Street 1:7316 JACKSON ARCH DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4721
Practice Address - Country:US
Practice Address - Phone:804-677-6958
Practice Address - Fax:804-677-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006937251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008510Medicaid
NC6008510Medicaid