| Medicina Mentis Ad Gloriam Dei Pllc | |
|
328 Office Square Ln Ste 104 Virginia Beach VA 23462-3648 | |
| (757) 490-9500 | |
| Not Available |
| Full Name | Medicina Mentis Ad Gloriam Dei Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 328 Office Square Ln Ste 104, Virginia Beach, Virginia |
| Authorized Official Name and Position | Duane Matthew Lawrence (SENIOR CLINICIAN) |
| Authorized Official Contact | 7574909500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicina Mentis Ad Gloriam Dei Pllc 1083 Independence Blvd Ste 187 Virginia Beach VA 23455-5523 Ph: (757) 910-2270 | Medicina Mentis Ad Gloriam Dei Pllc 328 Office Square Ln Ste 104 Virginia Beach VA 23462-3648 Ph: (757) 490-9500 |
| NPI Number | 1285331462 |
|---|---|
| Provider Enumeration Date | 02/08/2023 |
| Last Update Date | 02/08/2023 |
| Certification Date | 02/08/2023 |
| Medicare PECOS PAC ID | 7618342189 |
|---|---|
| Medicare Enrollment ID | O20230414001138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285331462 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Duane Matthew Lawrence |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497718845 PECOS PAC ID: 7719125707 Enrollment ID: I20230414001485 |
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