Provider Demographics
NPI:1902957160
Name:MIMOSA CHRISTIAN COUNSELING CENTER
Entity type:Organization
Organization Name:MIMOSA CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:BRIDGES
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, NCC
Authorized Official - Phone:828-433-5600
Mailing Address - Street 1:220 BURKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4454
Mailing Address - Country:US
Mailing Address - Phone:828-433-5600
Mailing Address - Fax:828-433-5656
Practice Address - Street 1:220 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4454
Practice Address - Country:US
Practice Address - Phone:828-433-5600
Practice Address - Fax:828-433-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC1549103T00000X
NC1907103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015X3OtherBCBSNC