Healthcare Provider Details

I. General information

NPI: 1962002931
Provider Name (Legal Business Name): MIND OVER MOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CARLOS DRIVE
GARYSBURG NC
27831
US

IV. Provider business mailing address

PO BOX 193
GARYSBURG NC
27831-0193
US

V. Phone/Fax

Practice location:
  • Phone: 252-365-7081
  • Fax:
Mailing address:
  • Phone: 252-365-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REKETER LYNETTE BARBER
Title or Position: CEO/ FOUNDER
Credential:
Phone: 252-365-7081