Healthcare Provider Details

I. General information

NPI: 1336767961
Provider Name (Legal Business Name): MIND & BODY THERAPEUTIC CONNECTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 US 70 HWY E
GARNER NC
27529-3982
US

IV. Provider business mailing address

136 US 70 HWY E
GARNER NC
27529-3982
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-5611
  • Fax:
Mailing address:
  • Phone: 919-791-5611
  • Fax: 919-342-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SUSANN HOPPMANN NAVARRA
Title or Position: OWNER
Credential:
Phone: 919-791-5611