Healthcare Provider Details

I. General information

NPI: 1245680768
Provider Name (Legal Business Name): MIND AND SPIRIT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 BASIN CREEK RD
BURLINGTON NC
27217-7353
US

IV. Provider business mailing address

1926 BASIN CREEK RD
BURLINGTON NC
27217-7353
US

V. Phone/Fax

Practice location:
  • Phone: 336-612-1747
  • Fax:
Mailing address:
  • Phone: 336-612-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. SUSAN L. BOWEN
Title or Position: COUNSELOR
Credential: NCFBPPC
Phone: 336-612-1747