Healthcare Provider Details

I. General information

NPI: 1922817972
Provider Name (Legal Business Name): MINDFUL HORIZONS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 RUTH AVE
DAYTON OH
45417-3612
US

IV. Provider business mailing address

945 RUTH AVE
DAYTON OH
45417-3612
US

V. Phone/Fax

Practice location:
  • Phone: 937-977-5255
  • Fax:
Mailing address:
  • Phone: 937-977-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARVA DENISE CARTER
Title or Position: OWNER/CLINICIAN
Credential: LCP, LICDC
Phone: 937-977-5255