Provider Demographics
NPI:1073022950
Name:MIND AND BODY CONNECTIONS LLC
Entity Type:Organization
Organization Name:MIND AND BODY CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WRONETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC, PMHNP-
Authorized Official - Phone:337-290-0745
Mailing Address - Street 1:2161 BABE ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-3252
Mailing Address - Country:US
Mailing Address - Phone:337-290-0745
Mailing Address - Fax:
Practice Address - Street 1:117 MARIE STREET
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584
Practice Address - Country:US
Practice Address - Phone:337-678-0366
Practice Address - Fax:337-223-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-24
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04507363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty