Provider Demographics
NPI:1003673419
Name:MINDFUL-WELL, CDC
Entity Type:Organization
Organization Name:MINDFUL-WELL, CDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:267-810-7593
Mailing Address - Street 1:261 OLD YORK RD STE 709
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3728
Mailing Address - Country:US
Mailing Address - Phone:215-917-5538
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 709
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3728
Practice Address - Country:US
Practice Address - Phone:215-917-5538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty