Provider Demographics
NPI:1487424115
Name:MILDER TOUCH MENTAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:MILDER TOUCH MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP- PSYCHIATRIC
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWASEYI
Authorized Official - Middle Name:LADIPUPO
Authorized Official - Last Name:SOETAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:424-622-8428
Mailing Address - Street 1:5706 GOSSAMER CT
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2339
Mailing Address - Country:US
Mailing Address - Phone:540-204-2459
Mailing Address - Fax:
Practice Address - Street 1:591 OAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9339
Practice Address - Country:US
Practice Address - Phone:443-842-4253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty