Provider Demographics
NPI:1427802560
Name:MINDFULL WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:MINDFULL WELLNESS SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:COAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-721-8255
Mailing Address - Street 1:5809 MERTON CT APT 381
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5848
Mailing Address - Country:US
Mailing Address - Phone:719-373-9777
Mailing Address - Fax:
Practice Address - Street 1:5809 MERTON CT APT 381
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5848
Practice Address - Country:US
Practice Address - Phone:719-373-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health