Provider Demographics
NPI:1407526171
Name:MENDING HEARTS COACHING AND COUNSELING, LLC
Entity Type:Organization
Organization Name:MENDING HEARTS COACHING AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA(NHA)
Authorized Official - Phone:304-240-2698
Mailing Address - Street 1:1314 EDWIN MILLER BLVD, STE 210
Mailing Address - Street 2:1314 EDWIN MILLER BLVD, STE 210
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404
Mailing Address - Country:US
Mailing Address - Phone:304-616-9566
Mailing Address - Fax:
Practice Address - Street 1:1314 EDWIN MILLER BLVD, STE 210
Practice Address - Street 2:1314 EDWIN MILLER BLVD, STE 210
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404
Practice Address - Country:US
Practice Address - Phone:304-616-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty