Healthcare Provider Details

I. General information

NPI: 1538092093
Provider Name (Legal Business Name): MINDFUL JOURNEY BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 BLACKSMITH DR
RALEIGH NC
27606-7701
US

IV. Provider business mailing address

3350 FOOTBRIDGE LN STE 124
FAYETTEVILLE NC
28306-9695
US

V. Phone/Fax

Practice location:
  • Phone: 910-644-0081
  • Fax:
Mailing address:
  • Phone: 910-644-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANAIS MENDIETA
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW, LCAS
Phone: 910-920-5630