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General NPI Number Information
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NPI Number | 1609521533
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Entity Type | Organization
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Legal Business Name | MENDING MINDS LLC
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 2333 ALEXANDRIA DR
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City | LEXINGTON
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State | KY
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Zip | 40504-3215
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Country | US
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Telephone | 336-602-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 228 BARONS RD
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City | CLEMMONS
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State | NC
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Zip | 27012-7203
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Country | US
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Telephone | 336-602-8266
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JONATHAN RUMLEY
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Credential |
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Telephone | 336-602-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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