Provider Demographics
NPI:1154191328
Name:MINDFUL HEALING GROUP LLC
Entity type:Organization
Organization Name:MINDFUL HEALING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-209-4122
Mailing Address - Street 1:5000 CENTRE GREEN WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5821
Mailing Address - Country:US
Mailing Address - Phone:910-302-6740
Mailing Address - Fax:
Practice Address - Street 1:136 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6711
Practice Address - Country:US
Practice Address - Phone:910-818-4957
Practice Address - Fax:910-500-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)