Provider Demographics
NPI:1376304063
Name:ESSENCE OF THE MIND BEHAVIORAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ESSENCE OF THE MIND BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:TANDI
Authorized Official - Middle Name:W
Authorized Official - Last Name:FORTIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:864-208-9501
Mailing Address - Street 1:25 WOODS LAKE RD STE 321
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2762
Mailing Address - Country:US
Mailing Address - Phone:864-208-9501
Mailing Address - Fax:864-849-7759
Practice Address - Street 1:25 WOODS LAKE RD STE 321
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2762
Practice Address - Country:US
Practice Address - Phone:864-208-9501
Practice Address - Fax:864-849-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty