Organization Active NPI

Mindful Willow Wellness PLLC

  • Clinical Social Worker
  • Raleigh, NC
National Provider Identifier
1265396642
Registry record updated Feb 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MINDFUL WILLOW WELLNESS PLLC
Practice address
205 W Millbrook Rd Ste 205
Raleigh, NC 27609-4492
Phone
(919) 699-5450
NPI assigned
Dec 10, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eliza Russ, LCSW, CEDS-CNPI 1982123048
Title
Owner/Therapist
Phone
(919) 699-5450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

205 W Millbrook Rd Ste 205
Raleigh, NC 27609-4492

Mailing address

2416 Treen St
Raleigh, NC 27614-7430
Phone (919) 699-5450

Other practice location 1

2416 Treen St
Raleigh, NC 27614-7430
Phone (919) 699-5450

National Provider Directory

National Provider Directory

Locations

205 W Millbrook Rd
Ste 205
Raleigh, NC 27609
Phone (919) 699-5450

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1765324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771632000000",
    "number": "1265396642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 TREEN ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276147430",
            "telephone_number": "919-699-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W MILLBROOK RD STE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094492",
            "telephone_number": "919-699-5450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2416 Treen St",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276147430",
            "country_code": "US",
            "telephone_number": "919-699-5450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDFUL WILLOW WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-10",
        "last_updated": "2026-02-21",
        "certification_date": "2026-02-21",
        "status": "A",
        "authorized_official_last_name": "RUSS",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "919-699-5450",
        "authorized_official_credential": "LCSW, CEDS-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.