Provider Demographics
NPI:1003640814
Name:MINDFUL JOURNEY COUNSELING LLC
Entity type:Organization
Organization Name:MINDFUL JOURNEY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-629-1738
Mailing Address - Street 1:7825 BROAD RIVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2375
Mailing Address - Country:US
Mailing Address - Phone:803-262-0794
Mailing Address - Fax:
Practice Address - Street 1:7825 BROAD RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2375
Practice Address - Country:US
Practice Address - Phone:803-262-0794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty