Provider Demographics
NPI:1417144106
Name:PEACE OF MIND, INC.
Entity Type:Organization
Organization Name:PEACE OF MIND, INC.
Other - Org Name:MOLLY VANDUSER, LPC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANDUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, LPC, NCC
Authorized Official - Phone:910-814-2197
Mailing Address - Street 1:PO BOX 2088
Mailing Address - Street 2:817 WEST FRONT STREET
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9735
Mailing Address - Country:US
Mailing Address - Phone:910-814-2197
Mailing Address - Fax:910-814-2167
Practice Address - Street 1:817 W FRONT ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9735
Practice Address - Country:US
Practice Address - Phone:910-814-2197
Practice Address - Fax:910-814-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC600502017OtherMAGELLAN
NCP-130377OtherMEDCOST
NC6006249Medicaid
NC147JEOtherBLUE CROSS
NC370742OtherTRICARE PRIME AND STANDARD