Healthcare Provider Details

I. General information

NPI: 1902394273
Provider Name (Legal Business Name): MANDI DUGGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STONEBURY DR
ARDEN NC
28704-6616
US

IV. Provider business mailing address

2 STONEBURY DR
ARDEN NC
28704-6616
US

V. Phone/Fax

Practice location:
  • Phone: 561-702-7482
  • Fax: 561-828-7720
Mailing address:
  • Phone: 561-702-7482
  • Fax: 561-828-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH8930
License Number StateFL

VIII. Authorized Official

Name: MANDI RENEE DUGGAN
Title or Position: OWNER
Credential:
Phone: 561-702-7482