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General NPI Number Information
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NPI Number | 1942860267
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Entity Type | Organization
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Legal Business Name | ENKINDLED MINDS COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 2507 SPRINGS RD
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City | VALLEJO
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State | CA
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Zip | 94591-5612
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Country | US
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Telephone | 707-515-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 2507 SPRINGS RD
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City | VALLEJO
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State | CA
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Zip | 94591-5612
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Country | US
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Telephone | 707-515-0612
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. NICOLE LADNER-PACE
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Credential | CSW
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Telephone | 707-515-0612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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