Provider Demographics
NPI:1982946372
Name:MINDLIFE MATTERS, PC
Entity Type:Organization
Organization Name:MINDLIFE MATTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIAT
Authorized Official - Middle Name:GERBER
Authorized Official - Last Name:HANDING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:646-438-0437
Mailing Address - Street 1:3504 VEST MILL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2985
Mailing Address - Country:US
Mailing Address - Phone:336-791-2311
Mailing Address - Fax:336-791-2312
Practice Address - Street 1:3504 VEST MILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2985
Practice Address - Country:US
Practice Address - Phone:336-791-2311
Practice Address - Fax:336-791-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-23
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1362101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty