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General NPI Number Information
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NPI Number | 1225303068
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Entity Type | Organization
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Legal Business Name | MINDFUL SOLUTION, LLC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 1 COMMERCE DR SUITE 205
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City | HATTIESBURG
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State | MS
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Zip | 39402-1499
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Country | US
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Telephone | 601-336-0347
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COMMERCE DR SUITE 205
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City | HATTIESBURG
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State | MS
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Zip | 39402-1499
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Country | US
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Telephone | 601-336-0347
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. SIDDEEQAH DAAIYAH BILAL
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Credential | MD
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Telephone | 601-291-5951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 21181
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License Number State | MS
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