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1811833643 NPI number — MINDFUL THERAPEUTIC COMMUNITY SUPPORT PROGRAM

NPI Number: 1811833643
Health Care Provider/Practitioner: MINDFUL THERAPEUTIC COMMUNITY SUPPORT PROGRAM

Information about “1811833643” NPI (MINDFUL THERAPEUTIC COMMUNITY SUPPORT PROGRAM) exists in 1811833643 in HTML format HTML  |  1811833643 in plain Text format TXT  |  1811833643 in PDF (Portable Document Format) PDF  |  1811833643 in an XML format XML  formats.

NPI Number : 1811833643 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811833643",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MINDFUL THERAPEUTIC COMMUNITY SUPPORT PROGRAM",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1981 EASTCHESTER DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HIGH POINT",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27265",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-905-8011",
    "MailingAddressFaxNumber": "336-905-8097",
    "FirstLinePracticeLocationAddress": "1981 EASTCHESTER DRIVE",
    "SecondLinePracticeLocationAddress": "STE B",
    "PracticeLocationAddressCityName": "HIGH POINT",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27265",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-905-8011",
    "PracticeLocationAddressFaxNumber": "336-905-8097",
    "EnumerationDate": "04/24/2026",
    "LastUpdateDate": "04/24/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MONTAGUE",
    "AuthorizedOfficialFirstName": "CRYSTAL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ORGANIZATIONAL DIRECTOR/QP",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP, FNP-C, PMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "336-905-8011",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251C00000X",
          "TaxonomyName": "Developmentally Disabled Services Day Training Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "343900000X",
          "TaxonomyName": "Non-emergency Medical Transport (VAN)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "347C00000X",
          "TaxonomyName": "Private Vehicle",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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