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General NPI Number Information
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NPI Number | 1730708868
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Entity Type | Organization
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Legal Business Name | MIND WELLNESS CENTER
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 331 E MAIN ST STE 200
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City | ROCK HILL
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State | SC
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Zip | 29730-5384
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Country | US
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Telephone | 704-350-5885
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Fax | 936-244-4599
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Provider Business Mailing Address
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Address Line | 7819 JAARS RD
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City | WAXHAW
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State | NC
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Zip | 28173-7677
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Country | US
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Telephone | 704-350-5885
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Fax | 704-843-4343
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Authorized Official
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Title or Position | OWNER
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Name | MR. KELLY SVEDBERG
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Credential | PA-C
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Telephone | 704-350-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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