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. I treat a broad variety of mental health conditions through a combination of careful medication prescription and management, integrated psychotherapy, and therapeutic connection most of all.
About:
I opened this practice to offer a different style of psychiatric care than what is typically possible in large, corporate mental health settings. I believe in prioritizing the therapeutic alliance and centering the patient's experience when working together. I am a solo-practitioner, one-person operation. I began this practice to offer an alternative to corporate, generic, assembly-line mental health care. My approach is collaborative and individualized. Your lived experience is centered and valued in our work together. My goal is to create a space where individuals whose identities have historically been marginalized and harmed by psychiatry - namely people of color, queer and gender non-conforming people, and women - can develop a sense of safety and trust knowing that mental health treatment does not require submission to the mental health system.
About me:
I have been a PMHNP since 2017, and before that a psychiatric nurse since 2013. I received both my BSN and MSN at Virginia Commonwealth University, where I have also served as adjunct faculty. I've worked in many different settings, including acute inpatient, eating disorders, child and adolescent, PHP and IOP, consult liaison, and corrections. I am a proud "masshole" and was born and raised in Cambridge, MA. I made my way to Virginia to live in an egalitarian intentional community of about 100 where income and resources where shared. After two years there, I moved to Oakland, CA to earn 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. It was there that. I learned what a nurse practitioner was and immediately felt called to the role. 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.
Please note:
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.
