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General NPI Number Information
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NPI Number | 1871261297
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND, BODY, AND SPIRIT PA
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 1631 KARA CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2052
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Country | US
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Telephone | 910-583-3693
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Fax |
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Provider Business Mailing Address
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Address Line | 1631 KARA CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2052
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Country | US
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Telephone | 910-583-3693
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ADRIENNE OWENS MONROE
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Credential | PHD, LCSW,SWS, QS
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Telephone | 910-583-3693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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