Provider Demographics
NPI:1275816258
Name:MINDMATTERS HYPNOSIS AND COUNSELING, INC.
Entity Type:Organization
Organization Name:MINDMATTERS HYPNOSIS AND COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:BOMBARDIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-932-5788
Mailing Address - Street 1:1513 CRIPPLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-5760
Mailing Address - Country:US
Mailing Address - Phone:704-932-5788
Mailing Address - Fax:
Practice Address - Street 1:10225 HICKORYWOOD HILL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3430
Practice Address - Country:US
Practice Address - Phone:704-796-8542
Practice Address - Fax:704-932-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0013781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003483Medicaid