Firefly Collaborative Mental Health
Inclusive psychiatric care for children, adolescents, and adults in Richmond and greater Virginia.
Welcome!
Thank you for visiting! My name is Margaret (she/her), and I’m a Psychiatric-Mental Health Nurse Practitioner (PMHNP). I focus on treating the mental health needs of the neurodivergent and queer community. I treat children through young adults and provide in-person care at my Richmond office as well as telehealth throughout Virginia.
About my practice:
I opened this practice to offer a different style of psychiatric care than what is typically possible in large, corporate mental health settings. My goal is to provide personal, individualized, trauma-informed care that centers the therapeutic alliance and a genuine human relationship rather than reductionist “medication management.” I treat conditions including depression and other mood disorders, anxiety, panic, PTSD, OCD, and ADHD through an integrated approach that combines medication management and therapy with an emphasis on dialectical behavioral therapy, logotherapy, and existential therapy. while prescribing psychiatric medications is important to the work we do together, I am conservative in how I prescribe with the goal of minimizing polypharmacy and utilizing the fewest medications needed to reach our therapeutic goals. My initial intake appointments are 90 minutes and follow-ups are 30-45 minutes depending on the need. While there is much overlap, I am not a psychotherapist per se, and most of my patients work with a therapist alongside myself with the goal of maintaining close collaboration.
Practice philosophy:
My practice is explicitly trauma-informed, neurodiversity affirming, queer and trans affirming, anti-racist, and anti-ablist. This means:
I commit to centering and valuing your lived experience. I will not dismiss or invalidate your concerns. I commit to affirming and valuing all neurotypes, races, gender identities, sexual and relational orientations and disability status.
I believe in acknowledging and confronting the violence psychiatry has inflicted on marginalized populations throughout history, leaving a lasting and well-earned mistrust of the mental health system by so many who are still feeling its reverberations. I understand this mistrust and why seeking mental health care feels unsafe for so many. My hope is that by confronting this history and not brushing it under the rug, we can begin to carve out a place where everyone can feel safe getting the care and support they need.
This practice is grounded in affirming care. I work with patients whose values align with respect for neurodiversity, all gender identities and sexual orientations, racial equity, and disability justice. Racism, sexism, transphobia, homophobia, ablism are not tolerated under any circumstances.
About me:
I have been a PMHNP since 2017, and before that a psychiatric nurse since 2012. I received both my BSN and MSN at Virginia Commonwealth University, where I'm currently adjunct faculty for the PMHNP program. I've worked in many different settings, including acute inpatient, eating disorders, child and adolescent, PHP and IOP, consult liaison, corrections and substance abuse. I was born and raised in Cambridge, Massachusetts, a city I am proud to call home. I originally made my way to Virginia to live in an intentional community in VA, where 100 people lived and worked together on an income-sharing farm. I went on to move to Oakland, CA, where I earned my BA at Mills College with a major in French and Francophone Studies and a minor in psychology. At Mills, I was inducted into the Phi Beta Kappa honor society and won the French Prize. I have three daughters, each born at home with under the care of an incredible midwife (IFKYK). I'm married to a Richmond City firefighter. I am a musical theater fanatic with a particular passion for Les Mis. While I'm a cat person at heart, I currently have one Quaker parrot and three parakeets.
Important points to review:
As a solo practitioner without support staff, I have limitations on what I can provide. Please carefully review the following when determining if I'll be a good fit for you: I cannot provide crisis management, and do not provide any type of after hours call. I am not able to support individuals who need significant care outside of scheduled sessions. A larger practice with 24/7 call would be a more appropriate fit. My schedule is limited, and I can only rarely accommodate late afternoon appointments. If you are not able to meet before 3pm, I will not be a good fit for you. My initial evaluations are 90 minutes and follow-ups are 30 minutes, occasionally being increased to 45 minutes on an individual basis. If you have medical conditions that impact your psychiatric care and require extensive monitoring and medical oversight, you would be better served by an integrated medical/psychiatric practice, as I do not have the bandwidth to cross manage medical and psychiatric care. I do not provide detox or MAT - again, this requires a higher level of monitoring than I am capable of managing in a solo practice. I am conservative with controlled substances (stimulants, benzodiazepines) and have a strict controlled substance policy that must be signed. If you are currently on a controlled substance, I cannot guarantee I will continue that medication depending on clinical evaluation and judgment. I am not able to take individuals on high daily doses of benzodiazepines (Xanax, Ativan, Klonopin, etc) as such regimens are often dangerous and can present a medical risk and may require detox.
Insurance Accepted:
Cigna Anthem BCBS Aetna United Optum Oscar Oxford Sentara I utilize Headway for insurance verification and billing; before starting services together, you will need to make a Headway account so we can make sure I'm in your network. Please click below to verify insurance coverage before we start together. Any questions about insurance coverage, benefits, or billing should be directed to Headway, as I outsource the financial management of my practice to them.
Frequently asked questions:
Am I a good fit for your practice?
While I am comfortable treating a wide variety of mental health conditions, as a solo-practitioner without clinical or admin staff, I am unable to meet the needs of individuals with more acute mental health needs. This includes individuals who are frequently in crisis who require extensive support and communication outside of scheduled visits. I am not able to provide crisis support nor be on-call; individuals requiring more intensive care are better served by a larger group practice that has multiple providers who can offer 24/7 call and may be able to facilitate inpatient admission when needed.
Do you provide 24/7 crisis support?
No. As a solo-practitioner, I am limited in my ability to provide care outside of scheduled appointments. I am generally very responsive to messages (I use a HIPAA compliant messaging platform called Spruce for communication), but it may take me up to a day or two to respond. If you are in crisis, you will need to call 911 or go to your closest ED rather than wait for me to responde. For this reason, if your mental health needs are more acute, you will be better served by a larger practice with more support infrastructure in place and 24/7 call.
What medications do you prescribe?
With a focus on safety, efficacy, and tolerability, I can prescribe antidepressants, anxiolytics, mood stabilizers, antipsychotics, ADHD medications, and sedative-hypnotics. I abide by all FDA and DEA regulations in prescribing. If controlled substances are indicated, we have a Controlled Substance Agreement that outlines our precautions and requirements for the safe and appropriate use of these medications.
Will you continue my current medications?
It depends. It is important to let me know in advance what you are currently taking if you wish to continue. I prescribe controlled substances very conservatiely and do not prescribe benzodiazepines and stimulants at the same time. Safety is my top priority and I practice fully in line with DEA guidelines and regulations. Individuals must sign a controlled substance agreement prior to starting care with me.
What ages do you treat?
I treat children with no minimum age through young adults. I do not treat older adults as this population is better served by a practice more specialized in treating the conditions and concerns common in this demographic.
Do you take insurance?
Absolutely. Mental health care must be accesible to all. I am currently in-network with Aetna, Cigna, Anthem BCBS, United, Oxford, Optum, Oscar, Setara (in process) and others down the road.
Do you do telehealth or in-person care?
Both! I feel strongly about the value of in-person care to foster a more authentic connection and rapport, especially when working with children and adolescents. My office is located in Richmond's West End in the Balance RVA Wellness-Based Coworking Space. I do provide telehealth as well, which plays an important role of making mental healthcare more accessible for individuals who cannot access in-person care.
What can I expect from a visit?
Initial visits are 90 minutes long. Follow ups are generally 30-45 minutes. Frequency is tailored to the individual needs and preferences. We talk about overall mental health progress, goals, life events, anything on your mind. We discuss medications of course too - but in my practice, I do not do exclusive "med management" and while discussing and evaluating medications is a big part of what I do, I do not put prescribing and managing medications ahead of the larger clinical picture and human sitting in front of me.
What is a nurse practitioner?
Nurse practitioners (NPs) are advanced-practice nurses who begin as registered nurses and pursue education at the Master's or Doctoral level. After passing board exams, NPs are trained to evaluate, diagnose, prescribe medications, perform procedures, and interpret bloodwork, among other tasks. While some NPs require physician supervision, I practice autonomously but deeply value the expertise of psychiatrists and other physicians, seeking consultation when needed.
One advantage of NP care is that, as nurses first, we often spend up to 12 hours caring for patients, developing rapport, and managing acute situations. As a nurse, my priority was always to advocate for patients, since oftentimes, we are the only ones doing so. My years as an RN have been invaluable to my work as an NP. This experience has helped me build empathy and develop skills to de-escalate patients with acute psychosis, mania, and aggression, deeply shaping my approach to patient care.
Do you have a supervising physician?
I have autonomous practice, meaning I have practiced long enough to no longer require physician supervision. However, that does not mean I have ceased seeking supervision and collaboration from physicians. The best patient care results from collaboration among healthcare providers of every stripe (and abbreviation) - NP, MD, DO, PA, RN, RD, OT, PT. We all bring something unique to the table, and collaboration is at the heart of caring for patients.
Why the name Firefly Collaborative Mental Health?
Fireflies represent a light in the darkness and a sense of wonder and joy even in the darkest of times. Collaborative because collaboration with each patient is the heart of our approach. We develop treatment plans collaboratively and center your voice and your personal goals and priorities during our work together. Treatments are made collaboratively after carefully reviewing the risks and benefits of different treatment options. Questions and curiosity are encouraged, and decisions are never made unilaterally.
