Healthcare Provider Details

I. General information

NPI: 1811833643
Provider Name (Legal Business Name): MINDFUL THERAPEUTIC COMMUNITY SUPPORT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 EASTCHESTER DRIVE STE B
HIGH POINT NC
27265
US

IV. Provider business mailing address

1981 EASTCHESTER DRIVE
HIGH POINT NC
27265
US

V. Phone/Fax

Practice location:
  • Phone: 336-905-8011
  • Fax: 336-905-8097
Mailing address:
  • Phone: 336-905-8011
  • Fax: 336-905-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL MONTAGUE
Title or Position: ORGANIZATIONAL DIRECTOR/QP
Credential: DNP, FNP-C, PMHNP-BC
Phone: 336-905-8011