Provider Demographics
NPI:1750136941
Name:SIMPLY MIND OVER MATTER LLC
Entity type:Organization
Organization Name:SIMPLY MIND OVER MATTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-690-6648
Mailing Address - Street 1:6375 SWANNS STATION RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-7796
Mailing Address - Country:US
Mailing Address - Phone:910-690-6648
Mailing Address - Fax:
Practice Address - Street 1:5540 CENTERVIEW DR STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-8012
Practice Address - Country:US
Practice Address - Phone:910-690-6648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty