Provider Demographics
NPI:1881249449
Name:MINDFULNESS COUNSELING CENTER LLC
Entity type:Organization
Organization Name:MINDFULNESS COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-637-2804
Mailing Address - Street 1:404 VOUGHT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-8054
Mailing Address - Country:US
Mailing Address - Phone:570-637-2804
Mailing Address - Fax:
Practice Address - Street 1:1239 GOLDEN MILE RD
Practice Address - Street 2:STE 103
Practice Address - City:WYSOX
Practice Address - State:PA
Practice Address - Zip Code:18848-9409
Practice Address - Country:US
Practice Address - Phone:570-637-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty