Provider Demographics
NPI:1154035012
Name:MINDHEALTH BEHAVIORAL PLLC
Entity type:Organization
Organization Name:MINDHEALTH BEHAVIORAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:704-264-6208
Mailing Address - Street 1:311 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2608
Mailing Address - Country:US
Mailing Address - Phone:704-264-6208
Mailing Address - Fax:
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2608
Practice Address - Country:US
Practice Address - Phone:704-264-6208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)