Provider Demographics
NPI:1528580990
Name:MIND FITNESS CENTER
Entity Type:Organization
Organization Name:MIND FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:855-646-3123
Mailing Address - Street 1:225 W WINTON AVE STE 202D
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1219
Mailing Address - Country:US
Mailing Address - Phone:855-646-3123
Mailing Address - Fax:855-646-3123
Practice Address - Street 1:225 WEST. WINTON AVE
Practice Address - Street 2:SUITE 202D
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:855-646-3123
Practice Address - Fax:855-646-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 101YM0800X, 1041C0700X, 171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty