Healthcare Provider Details

I. General information

NPI: 1528580990
Provider Name (Legal Business Name): MIND FITNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 B ST
HAYWARD CA
94541-2917
US

IV. Provider business mailing address

1363 B ST
HAYWARD CA
94541-2917
US

V. Phone/Fax

Practice location:
  • Phone: 510-760-0276
  • Fax:
Mailing address:
  • Phone: 510-760-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. DARCELL J. SOCKWELL
Title or Position: CEO / DIRECTOR OF OPERATIONS
Credential: LMFT
Phone: 510-760-0276