Provider Demographics
NPI:1700225307
Name:SUCCESSFUL MINDS LLC
Entity Type:Organization
Organization Name:SUCCESSFUL MINDS LLC
Other - Org Name:ANNETTE W. BURSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER'S EDUCATION
Authorized Official - Phone:704-620-2575
Mailing Address - Street 1:2134 CAPERNIUM RD TRLR 2
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-9404
Mailing Address - Country:US
Mailing Address - Phone:704-620-2575
Mailing Address - Fax:
Practice Address - Street 1:2134 CAPERNIUM RD TRLR 2
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-9404
Practice Address - Country:US
Practice Address - Phone:704-620-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency