Provider Demographics
NPI:1124310396
Name:OPEN HEARTS OPEN MINDS
Entity type:Organization
Organization Name:OPEN HEARTS OPEN MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMINGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NBC
Authorized Official - Phone:704-536-0737
Mailing Address - Street 1:7609 DELUCA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5313
Mailing Address - Country:US
Mailing Address - Phone:704-536-0737
Mailing Address - Fax:
Practice Address - Street 1:7609 DELUCA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5313
Practice Address - Country:US
Practice Address - Phone:704-536-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YS0200X
NC5488101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty