Provider Demographics
NPI:1609521533
Name:MENDING MINDS LLC
Entity Type:Organization
Organization Name:MENDING MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-602-8266
Mailing Address - Street 1:228 BARONS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7203
Mailing Address - Country:US
Mailing Address - Phone:336-602-8266
Mailing Address - Fax:
Practice Address - Street 1:2333 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3215
Practice Address - Country:US
Practice Address - Phone:336-602-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty