Provider Demographics
NPI:1962002931
Name:MIND OVER MOOD
Entity Type:Organization
Organization Name:MIND OVER MOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:REKETER
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-365-7081
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:GARYSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27831-0193
Mailing Address - Country:US
Mailing Address - Phone:252-365-7081
Mailing Address - Fax:
Practice Address - Street 1:115 CARLOS DRIVE
Practice Address - Street 2:
Practice Address - City:GARYSBURG
Practice Address - State:NC
Practice Address - Zip Code:27831
Practice Address - Country:US
Practice Address - Phone:252-365-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty