Healthcare Provider Details

I. General information

NPI: 1588473037
Provider Name (Legal Business Name): MINDFULLY FIERCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARKET ST STE G09
CHAPEL HILL NC
27516-4056
US

IV. Provider business mailing address

1040 GALLUP RD
CHAPEL HILL NC
27517-8891
US

V. Phone/Fax

Practice location:
  • Phone: 919-391-4483
  • Fax:
Mailing address:
  • Phone: 919-391-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL MILLS-BRANTLEY
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LCSW
Phone: 919-391-4483