Provider Demographics
NPI:1548043052
Name:THE MIND GARDEN, LLC
Entity type:Organization
Organization Name:THE MIND GARDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, RESIDENT IN COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-343-5557
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-0365
Mailing Address - Country:US
Mailing Address - Phone:240-343-5557
Mailing Address - Fax:
Practice Address - Street 1:714 PINE ST # 1044
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4660
Practice Address - Country:US
Practice Address - Phone:240-343-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty