Provider Demographics
NPI:1891455614
Name:BLISSFUL MINDS LLC
Entity Type:Organization
Organization Name:BLISSFUL MINDS LLC
Other - Org Name:BLISSFUL MINDS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JALEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-434-4970
Mailing Address - Street 1:5222 W MARKET STREET EXT
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-5608
Mailing Address - Country:US
Mailing Address - Phone:910-434-4970
Mailing Address - Fax:
Practice Address - Street 1:110 DUVALL ST
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-2406
Practice Address - Country:US
Practice Address - Phone:910-434-4970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health