Healthcare Provider Details

I. General information

NPI: 1871337980
Provider Name (Legal Business Name): STATE OF MIND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CRIMSON POINTE DR
HARDEEVILLE SC
29927-2027
US

IV. Provider business mailing address

807 CRIMSON POINTE DR
HARDEEVILLE SC
29927-2027
US

V. Phone/Fax

Practice location:
  • Phone: 843-304-5857
  • Fax:
Mailing address:
  • Phone: 843-304-5857
  • Fax:

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: JULIA GWYNN
Title or Position: OWNER/CLINICIAN
Credential: LPC
Phone: 843-304-5857