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NPI Code Detail

MEDICARE: MOSAIC MENTAL WELLNESS

MEDICARE: MOSAIC MENTAL WELLNESS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114588241
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOSAIC MENTAL WELLNESS
Provider Business Mailing Address
First Line : 3005 PETERS CREEK RD NW
Second Line :
City : ROANOKE
State : VA
Zip : 24019-2738
Country : US
Telephone Number : 540-566-4034
Fax Number : 540-566-4472
Provider Business Practice Location Address
First Line : 3005 PETERS CREEK RD NW
Second Line :
City : ROANOKE
State : VA
Zip : 24019-2738
Country : US
Telephone Number : 540-520-1052
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DENEEN LOGAN EVANS
Credential :
Telephone Number : 540-566-4034
Provider Enumeration Date : 06/28/2019
Last Update Date : 05/11/2020

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Directions to “MOSAIC MENTAL WELLNESS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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