MEDICARE: PEACE OF MIND THERAPEUTIC SERVICES, PLLC

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	251S00000X	Community/Behavioral Health Agency	001881184	NC

General Provider Information

NPI Number	:	1992938807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE OF MIND THERAPEUTIC SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 11354
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-0354
Country	:	US
Telephone Number	:	919-294-6567
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 MURRAY HILL DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-3063
Country	:	US
Telephone Number	:	919-294-6567
Fax Number	:

Authorized Official
Title or Position	:	CEO/PSYCHOTHERAPIST
Name	:	MRS. ABENA BEDIAKO
Credential	:	LCSW
Telephone Number	:	919-294-6567

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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