MEDICARE: MINDFULL WELLNESS SOLUTIONS LLC

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
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427802560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFULL WELLNESS SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	5809 MERTON CT APT 381
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-5848
Country	:	US
Telephone Number	:	719-373-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	5809 MERTON CT APT 381
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-5848
Country	:	US
Telephone Number	:	719-373-9777
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS ALYSSA P COAN
Credential	:	LCSW
Telephone Number	:	703-721-8255

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	01/30/2026

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