Provider Demographics
NPI:1790486298
Name:MINDFUL WELLNESS COUNSELING, PC
Entity Type:Organization
Organization Name:MINDFUL WELLNESS COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BERRYHILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA
Authorized Official - Phone:910-939-8406
Mailing Address - Street 1:137 DOCKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9769
Mailing Address - Country:US
Mailing Address - Phone:910-939-8406
Mailing Address - Fax:
Practice Address - Street 1:714 W CORBETT AVE STE 12
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8437
Practice Address - Country:US
Practice Address - Phone:910-939-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty