Mission Mind Wellness, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MISSION MIND WELLNESS, LLC

Practice address

1318 Jamestown Rd Ste 102
Williamsburg, VA 23185-3382

Phone

(757) 231-5576

NPI assigned

Nov 4, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan MooreNPI 1821969916

Title

Co-Owner/Therapist

Phone

(757) 231-5576

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Moore

  • Clinical Social Worker
  • Williamsburg, VA
  • NPI 1821969916

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Jesalyn Moore, LCSW, LSATP, CAADC

  • Clinical Social Worker
  • Williamsburg, VA
  • NPI 1245685569

  Addiction (Substance Use Disorder)

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1144937541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 JAMESTOWN RD STE 102",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853382",
            "telephone_number": "757-231-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 JAMESTOWN RD STE 102",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853382",
            "telephone_number": "757-231-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION MIND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-04",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CO-OWNER/THERAPIST",
        "authorized_official_telephone_number": "757-231-5576"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coty Mills, LCSW
• Dominique Antawn Mills, LPC-R
• Katherine Mills
• Kristie Marlene Mishler, PHARM.D.
• Jennifer Mishoe, LMT
• Shawn Anthony Mitchell, DDS
• John Mitrovic, PT SCS ATC CSCS
• Spencer Ole Moen
• Angel Fernando Mogrovejo Fajardo, DDS, MS
• Abdul El Rahman Mohamed

• Clinical Social Worker in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.