Provider Demographics
NPI:1922416627
Name:CENTER FOR MINDFUL LIVING, LLC
Entity Type:Organization
Organization Name:CENTER FOR MINDFUL LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:301-910-5812
Mailing Address - Street 1:434 MARKET ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-2403
Mailing Address - Country:US
Mailing Address - Phone:301-910-5812
Mailing Address - Fax:
Practice Address - Street 1:434 MARKET ST
Practice Address - Street 2:SUITE 304
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2403
Practice Address - Country:US
Practice Address - Phone:301-910-5812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018132251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health