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General NPI Number Information
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NPI Number | 1629852918
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Entity Type | Organization
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Legal Business Name | MENDFUL MINDS WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 2737 N 5TH ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19133-2702
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Country | US
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Telephone | 267-831-2157
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Fax |
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Provider Business Mailing Address
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Address Line | 2 SCENIC VIEW DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-3012
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Country | US
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Telephone | 856-526-9652
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | CONSTANCE COURDUFF
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Credential | CRNP
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Telephone | 267-474-9003
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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