Healthcare Provider Details

I. General information

NPI: 1700725280
Provider Name (Legal Business Name): MIND PRIME COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 POTTSVILLE PIKE STE 101B
READING PA
19605-9707
US

IV. Provider business mailing address

118 COLONIAL DR APT F
READING PA
19607-3609
US

V. Phone/Fax

Practice location:
  • Phone: 484-451-8950
  • Fax:
Mailing address:
  • Phone: 717-829-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MCQUERNA NOLASCO-LOPEZ
Title or Position: FOUNDER
Credential: LPC
Phone: 717-829-7127