Healthcare Provider Details

I. General information

NPI: 1467774356
Provider Name (Legal Business Name): MINDFUL WELLBEING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 JILLSON WAY
EAST SANDWICH MA
02537-1265
US

IV. Provider business mailing address

11 JILLSON WAY
EAST SANDWICH MA
02537-1265
US

V. Phone/Fax

Practice location:
  • Phone: 508-833-1652
  • Fax: 774-413-9345
Mailing address:
  • Phone: 508-833-1652
  • Fax: 774-413-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number203553
License Number StateMA

VIII. Authorized Official

Name: MRS. ERIN T ACKLAND
Title or Position: OWNER
Credential: NP, CNS
Phone: 508-833-1652