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General NPI Number Information
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NPI Number | 1811833643
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Entity Type | Organization
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Legal Business Name | MINDFUL THERAPEUTIC COMMUNITY SUPPORT PROGRAM
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 1981 EASTCHESTER DRIVE STE B
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City | HIGH POINT
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State | NC
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Zip | 27265
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Country | US
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Telephone | 336-905-8011
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Fax | 336-905-8097
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Provider Business Mailing Address
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Address Line | 1981 EASTCHESTER DRIVE
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City | HIGH POINT
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State | NC
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Zip | 27265
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Country | US
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Telephone | 336-905-8011
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Fax | 336-905-8097
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Authorized Official
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Title or Position | ORGANIZATIONAL DIRECTOR/QP
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Name | DR. CRYSTAL MONTAGUE
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Credential | DNP, FNP-C, PMHNP-BC
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Telephone | 336-905-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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Taxonomy #4
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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Taxonomy #5
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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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