Provider Demographics
NPI:1659006740
Name:PEACEFUL MINDS COUNSELING AND CONSULTING, PLLC.
Entity Type:Organization
Organization Name:PEACEFUL MINDS COUNSELING AND CONSULTING, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:SIEDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:980-224-0239
Mailing Address - Street 1:13000 S TRYON ST STE F165
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7652
Mailing Address - Country:US
Mailing Address - Phone:704-492-8525
Mailing Address - Fax:
Practice Address - Street 1:13000 S TRYON ST STE F165
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7652
Practice Address - Country:US
Practice Address - Phone:704-492-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)