Provider Demographics
NPI:1336861335
Name:BODY & MIND WELLNESS
Entity Type:Organization
Organization Name:BODY & MIND WELLNESS
Other - Org Name:LIVING HEALTHY BODY & MIND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:803-629-1209
Mailing Address - Street 1:7001 SAINT ANDREWS RD STE 307
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:803-629-1209
Mailing Address - Fax:
Practice Address - Street 1:7001 SAINT ANDREWS RD STE 307
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1137
Practice Address - Country:US
Practice Address - Phone:803-629-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty