Provider Demographics
NPI:1073906335
Name:MIND BODY INSTITUTE OF THE PIEDMONT, PLLC
Entity Type:Organization
Organization Name:MIND BODY INSTITUTE OF THE PIEDMONT, PLLC
Other - Org Name:MIND BODY INSTITUTE BEYOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:336-298-8303
Mailing Address - Street 1:882 MONTRACHET CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8369
Mailing Address - Country:US
Mailing Address - Phone:336-298-8303
Mailing Address - Fax:
Practice Address - Street 1:450 W HANES MILL RD
Practice Address - Street 2:SUITE NUMBER 224
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9141
Practice Address - Country:US
Practice Address - Phone:336-298-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty