Provider Demographics
NPI:1497548994
Name:MINDFUL MOMENTUM, LLC
Entity type:Organization
Organization Name:MINDFUL MOMENTUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR-ASSOCIATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:803-250-1375
Mailing Address - Street 1:313 WINDELL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6526
Mailing Address - Country:US
Mailing Address - Phone:803-250-1375
Mailing Address - Fax:
Practice Address - Street 1:313 WINDELL DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6526
Practice Address - Country:US
Practice Address - Phone:803-250-1375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-27
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty