Provider Demographics
NPI:1184479925
Name:MINDSET OF OPTIMISM
Entity type:Organization
Organization Name:MINDSET OF OPTIMISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-260-0429
Mailing Address - Street 1:4 KIT AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-6770
Mailing Address - Country:US
Mailing Address - Phone:803-445-5646
Mailing Address - Fax:
Practice Address - Street 1:4 KIT AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-6770
Practice Address - Country:US
Practice Address - Phone:803-260-0429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty