Healthcare Provider Details

I. General information

NPI: 1003673419
Provider Name (Legal Business Name): MINDFUL-WELL, CDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WASHINGTON LN STE 3A
WYNCOTE PA
19095-1425
US

IV. Provider business mailing address

25 WASHINGTON LN STE 3A
WYNCOTE PA
19095-1425
US

V. Phone/Fax

Practice location:
  • Phone: 267-810-7594
  • Fax:
Mailing address:
  • Phone: 267-810-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LATONYA MCCURRY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 267-810-7593