Provider Demographics
NPI:1114791423
Name:THE MINDFULNESS SPACE PSYCHOTHERAPY SERVICES, PLLC.
Entity Type:Organization
Organization Name:THE MINDFULNESS SPACE PSYCHOTHERAPY SERVICES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-916-1584
Mailing Address - Street 1:717 GREEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2156
Mailing Address - Country:US
Mailing Address - Phone:336-916-1584
Mailing Address - Fax:
Practice Address - Street 1:717 GREEN VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2156
Practice Address - Country:US
Practice Address - Phone:336-916-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MINDFULNESS SPACE PSYCHOTHERAPY SERVICES, PLLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health