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General NPI Number Information
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NPI Number | 1699543876
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Entity Type | Organization
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Legal Business Name | MIND-BODY CONNECTION COUNSELING PLLC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 01/06/2024
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Provider Practice Location Address
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Address Line | 626 N MAIN ST
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City | WAYNESVILLE
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State | NC
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Zip | 28786-3820
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Country | US
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Telephone | 828-283-0113
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Fax | 828-246-0254
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | BALSAM
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State | NC
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Zip | 28707-0146
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Country | US
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Telephone | 828-283-0113
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Fax | 828-246-0254
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARIA AVERZA
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Credential | LCMHC
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Telephone | 828-233-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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