Provider Demographics
NPI:1871261297
Name:PEACE OF MIND, BODY, AND SPIRIT PA
Entity Type:Organization
Organization Name:PEACE OF MIND, BODY, AND SPIRIT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:OWENS
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW,SWS, QS
Authorized Official - Phone:910-583-3693
Mailing Address - Street 1:1631 KARA CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2052
Mailing Address - Country:US
Mailing Address - Phone:910-583-3693
Mailing Address - Fax:
Practice Address - Street 1:1631 KARA CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2052
Practice Address - Country:US
Practice Address - Phone:910-583-3693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty