Provider Demographics
NPI:1396262085
Name:HEALING MINDS THERAPEUTIC SERVICES, PLLC
Entity type:Organization
Organization Name:HEALING MINDS THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCAS
Authorized Official - Phone:910-489-0429
Mailing Address - Street 1:5524 BEAR CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4899
Mailing Address - Country:US
Mailing Address - Phone:910-489-0429
Mailing Address - Fax:
Practice Address - Street 1:4140 RAMSEY ST STE 108
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7658
Practice Address - Country:US
Practice Address - Phone:910-580-9346
Practice Address - Fax:910-229-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2305101YA0400X
NC9092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty