Provider Demographics
NPI:1972181642
Name:REFRESHED MINDS AND WELLNESS LLC
Entity Type:Organization
Organization Name:REFRESHED MINDS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNDELE
Authorized Official - Middle Name:LANIK
Authorized Official - Last Name:DANZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-518-9079
Mailing Address - Street 1:6047 TYVOLA GLEN CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6431
Mailing Address - Country:US
Mailing Address - Phone:704-626-6855
Mailing Address - Fax:704-626-6855
Practice Address - Street 1:6047 TYVOLA GLEN CIR STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6431
Practice Address - Country:US
Practice Address - Phone:704-626-6855
Practice Address - Fax:704-626-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty