Healthcare Provider Details

I. General information

NPI: 1740476134
Provider Name (Legal Business Name): MENTORING MINDS FOR MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SHIPYARD BLVD SUITE 100
WILMINGTON NC
28403
US

IV. Provider business mailing address

4000 SHIPYARD BLVD SUITE 100
WILMINGTON NC
28403-6192
US

V. Phone/Fax

Practice location:
  • Phone: 910-796-7848
  • Fax: 910-796-7849
Mailing address:
  • Phone: 910-796-7848
  • Fax: 910-796-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2572
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2572
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2572
License Number StateNC

VIII. Authorized Official

Name: DR. DENISE JOAN HANSON
Title or Position: LICENSED PSYCHOLOGIST/OWNER
Credential: PSY.D.
Phone: 910-792-5570