Provider Demographics
NPI:1265151674
Name:BEAUTIFUL MINDZ BEHAVIORAL HEALTH AND WELLNESS PLLC
Entity type:Organization
Organization Name:BEAUTIFUL MINDZ BEHAVIORAL HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, PMHNP-BC
Authorized Official - Phone:704-322-9156
Mailing Address - Street 1:4363 TUCKER CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-7812
Mailing Address - Country:US
Mailing Address - Phone:704-322-9156
Mailing Address - Fax:
Practice Address - Street 1:4363 TUCKER CHASE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-7812
Practice Address - Country:US
Practice Address - Phone:704-322-9156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health