Provider Demographics
NPI:1366066938
Name:MIND HEART CONNECTION LLC
Entity type:Organization
Organization Name:MIND HEART CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BLEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-295-1968
Mailing Address - Street 1:820 MAPLE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7566
Mailing Address - Country:US
Mailing Address - Phone:757-295-1968
Mailing Address - Fax:
Practice Address - Street 1:820 MAPLE FOREST CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7566
Practice Address - Country:US
Practice Address - Phone:757-295-1968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty