Healthcare Provider Details

I. General information

NPI: 1043975048
Provider Name (Legal Business Name): MINDFUL INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date: 08/07/2023
Reactivation Date: 08/18/2023

III. Provider practice location address

4154 MENDENHALL OAKS PKWY STE 103
HIGH POINT NC
27265-8034
US

IV. Provider business mailing address

1155 DOUBLE POND LN
HIGH POINT NC
27265-9242
US

V. Phone/Fax

Practice location:
  • Phone: 336-847-1626
  • Fax:
Mailing address:
  • Phone: 336-847-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL JENITA MONTAGUE
Title or Position: CEO
Credential:
Phone: 336-847-1626