Provider Demographics
NPI:1790404317
Name:MIND, BODY AND SOUL COUNSELING LLC
Entity Type:Organization
Organization Name:MIND, BODY AND SOUL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDELYN
Authorized Official - Middle Name:MARTINA
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-938-8495
Mailing Address - Street 1:491 BALTIMORE PIKE STE 1134
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3810
Mailing Address - Country:US
Mailing Address - Phone:484-938-8495
Mailing Address - Fax:
Practice Address - Street 1:4022 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3406
Practice Address - Country:US
Practice Address - Phone:484-938-8495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty