Provider Demographics
NPI:1194382085
Name:MINDFUL PATHS PLLC
Entity Type:Organization
Organization Name:MINDFUL PATHS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILINGUAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADRIN-TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-295-2280
Mailing Address - Street 1:6 RED SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-3394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2003 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1109
Practice Address - Country:US
Practice Address - Phone:919-455-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-25
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1669821286Medicaid