Healthcare Provider Details

I. General information

NPI: 1336861335
Provider Name (Legal Business Name): BODY & MIND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 SAINT ANDREWS RD STE 307
COLUMBIA SC
29212-1137
US

IV. Provider business mailing address

7001 SAINT ANDREWS RD STE 307
COLUMBIA SC
29212-1137
US

V. Phone/Fax

Practice location:
  • Phone: 803-629-1209
  • Fax:
Mailing address:
  • Phone: 803-629-1209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: KRISTY L THOMPSON
Title or Position: OWNER
Credential: NP
Phone: 803-629-1209