Provider Demographics
NPI:1205392099
Name:MINDFUL MOVEMENTS, PLLC
Entity Type:Organization
Organization Name:MINDFUL MOVEMENTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LCAS, NCC
Authorized Official - Phone:248-396-8810
Mailing Address - Street 1:401 DEER BRUSH LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6307
Mailing Address - Country:US
Mailing Address - Phone:248-396-8810
Mailing Address - Fax:
Practice Address - Street 1:1118 SAM NEWELL RD STE D1ANDD4
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5041
Practice Address - Country:US
Practice Address - Phone:248-396-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-16
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty