Healthcare Provider Details

I. General information

NPI: 1306774674
Provider Name (Legal Business Name): KAREN TUCKER THAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MINDFUL BEGINNINGS OF LAKE NORMAN 17115 KENTON DR. 202A
CORNELIUS NC
28031
US

IV. Provider business mailing address

13005 HEATH GROVE DR
HUNTERSVILLE NC
28078-4236
US

V. Phone/Fax

Practice location:
  • Phone: 704-737-1974
  • Fax:
Mailing address:
  • Phone: 704-737-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA21854
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: