Healthcare Provider Details

I. General information

NPI: 1962297796
Provider Name (Legal Business Name): MIND FULL CENTER FOR WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 TAUNTON AVE
NORTON MA
02766-3504
US

IV. Provider business mailing address

306 TAUNTON AVE
NORTON MA
02766-3504
US

V. Phone/Fax

Practice location:
  • Phone: 508-470-9783
  • Fax: 508-231-9020
Mailing address:
  • Phone: 508-470-9783
  • Fax: 508-231-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAWN MARIE DECOSTA
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 603-391-2392