Mental Wellness Residential

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

MENTAL WELLNESS RESIDENTIAL

Practice address

1420 Spruce Street Extrension
Martinsville, VA 24412

Phone

(276) 790-3473

Fax

(276) 632-2010

NPI assigned

Jun 14, 2017

Last updated

Jun 14, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Valerie B Udofia

Title

Ceo

Phone

(919) 697-7991

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497398400000",
    "number": "1427588227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3628",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241153628",
            "telephone_number": "919-697-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 SPRUCE STREET EXTRENSION",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "24412",
            "telephone_number": "276-790-3473",
            "fax_number": "276-632-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL WELLNESS RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-14",
        "last_updated": "2017-06-14",
        "status": "A",
        "authorized_official_last_name": "UDOFIA",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-697-7991",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa McIntosh, LPC
• James Coley McKay, M.D.
• Medexpress Urgent Care, PC - Virginia (MedExpress Urgent Care - Martinsville, W Commonwealth Blvd)
• Medical Services of America Inc (Medi Home Care)
• Menm, LLC (Miracle-Ear)
• Carrie Ann Metzger, LPC
• Tabatha Miller
• Ashlyn Millner
• Destiny Mitchell, LMHP-S
• Karen Leigh Mitchell, DPT

• Assisted Living Facility (Mental Illness) in Martinsville, VA
• Providers in Martinsville, VA by specialty
• Assisted Living Facility (Mental Illness) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2017; 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.