Provider Demographics
NPI:1497320485
Name:MINDFUL LIVING COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:MINDFUL LIVING COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:VACCA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:914-414-4497
Mailing Address - Street 1:1705 NUTMEG DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2603
Mailing Address - Country:US
Mailing Address - Phone:914-414-4497
Mailing Address - Fax:
Practice Address - Street 1:1705 NUTMEG DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2603
Practice Address - Country:US
Practice Address - Phone:914-414-4497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE