Healthcare Provider Details

I. General information

NPI: 1831982933
Provider Name (Legal Business Name): MINDFUL MOMENTS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ROUTE 38 STE 11-603
MOUNT LAUREL NJ
08054-9754
US

IV. Provider business mailing address

6503 COVENTRY WAY
MOUNT LAUREL NJ
08054-6828
US

V. Phone/Fax

Practice location:
  • Phone: 856-313-6686
  • Fax: 856-313-6686
Mailing address:
  • Phone: 856-313-6686
  • Fax: 856-313-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA J ZACHARIAS
Title or Position: OWNER/PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 856-313-6686