Provider Demographics
NPI:1720344740
Name:MINDFUL AWAKENING, PLLC
Entity Type:Organization
Organization Name:MINDFUL AWAKENING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-960-1088
Mailing Address - Street 1:1703 LEGION RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2359
Mailing Address - Country:US
Mailing Address - Phone:919-960-1088
Mailing Address - Fax:
Practice Address - Street 1:1703 LEGION RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2359
Practice Address - Country:US
Practice Address - Phone:919-960-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty