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General NPI Number Information
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NPI Number | 1548615917
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Entity Type | Organization
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Legal Business Name | MIRROR 2 THE HEART, PLLC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 4311 SCHOOL HOUSE CMNS # 178
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City | HARRISBURG
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State | NC
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Zip | 28075-7510
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Country | US
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Telephone | 980-859-3331
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Fax | 888-730-1933
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Provider Business Mailing Address
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Address Line | 4311 SCHOOL HOUSE CMNS # 178
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City | HARRISBURG
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State | NC
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Zip | 28075-7510
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Country | US
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Telephone | 980-859-3331
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Fax | 888-730-1933
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Authorized Official
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Title or Position | CEO
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Name | MRS. STEPHANIE NICHOL BRISCOE
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Credential | LCMHC
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Telephone | 980-859-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 10549
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10549
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10549
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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