Healthcare Provider Details

I. General information

NPI: 1336085554
Provider Name (Legal Business Name): MIGHTY MINDFUL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 CHEAHA DR
RALEIGH NC
27616-2215
US

IV. Provider business mailing address

7821 CHEAHA DR APT 202
RALEIGH NC
27616-2217
US

V. Phone/Fax

Practice location:
  • Phone: 432-309-4336
  • Fax: 844-691-3116
Mailing address:
  • Phone: 432-309-4336
  • Fax: 844-691-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHARIYFA POLITE
Title or Position: CEO
Credential: LCSW
Phone: 432-309-4336