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General NPI Number Information
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NPI Number | 1801605498
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Entity Type | Organization
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Legal Business Name | MINDFUL LIVING COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 N STE 104
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City | MARLTON
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State | NJ
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Zip | 08053-3422
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Country | US
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Telephone | 973-553-4322
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Fax |
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Provider Business Mailing Address
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Address Line | 127 BADGER PASS DR
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City | CLAYTON
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State | NC
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Zip | 27527-9536
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Country | US
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Telephone | 862-209-0870
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/ LEAD CLINICIAN
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Name | MICIA HARRIS
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Credential | MA, LPC
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Telephone | 862-209-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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