Provider Demographics
NPI:1831590637
Name:MINDEASE SOLUTIONS, LLC
Entity type:Organization
Organization Name:MINDEASE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-903-4774
Mailing Address - Street 1:132 DRENNEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-6530
Mailing Address - Country:US
Mailing Address - Phone:304-903-4774
Mailing Address - Fax:
Practice Address - Street 1:132 DRENNEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954-6530
Practice Address - Country:US
Practice Address - Phone:304-903-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty