Provider Demographics
NPI:1811297948
Name:MINDSTREAM LLC
Entity type:Organization
Organization Name:MINDSTREAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PACITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MS;LMHC;NCC
Authorized Official - Phone:843-757-2192
Mailing Address - Street 1:11 GRASSEY LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6604
Mailing Address - Country:US
Mailing Address - Phone:843-757-2003
Mailing Address - Fax:
Practice Address - Street 1:11 GRASSEY LN
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6604
Practice Address - Country:US
Practice Address - Phone:843-757-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6634766101YM0800X
SC4940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty