Healthcare Provider Details

I. General information

NPI: 1114675246
Provider Name (Legal Business Name): MIND HEALING & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STAFFORD ST
WORCESTER MA
01603-1457
US

IV. Provider business mailing address

21 SW CUTOFF
NORTHBOROUGH MA
01532-2135
US

V. Phone/Fax

Practice location:
  • Phone: 508-344-7530
  • Fax:
Mailing address:
  • Phone: 508-826-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GRACE MBUYA
Title or Position: MANAGER
Credential: NP
Phone: 508-344-7530