Provider Demographics
NPI:1316711526
Name:MOVING MINDFUL THERAPY LLC
Entity type:Organization
Organization Name:MOVING MINDFUL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LISW-CP
Authorized Official - Phone:252-373-6280
Mailing Address - Street 1:241 BLANCHE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4905
Mailing Address - Country:US
Mailing Address - Phone:252-373-6280
Mailing Address - Fax:
Practice Address - Street 1:241 BLANCHE CIRCLE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:252-373-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty