Provider Demographics
NPI:1699543876
Name:MIND-BODY CONNECTION COUNSELING PLLC
Entity type:Organization
Organization Name:MIND-BODY CONNECTION COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:828-233-0113
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:BALSAM
Mailing Address - State:NC
Mailing Address - Zip Code:28707-0146
Mailing Address - Country:US
Mailing Address - Phone:828-283-0113
Mailing Address - Fax:828-246-0254
Practice Address - Street 1:626 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3820
Practice Address - Country:US
Practice Address - Phone:828-283-0113
Practice Address - Fax:828-246-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health