NPIMap

Organization Active NPI

Mindly Group, PLLC

  • Community/Behavioral Health Agency
  • Raleigh, NC
National Provider Identifier
1306196944
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MINDLY GROUP, PLLC
Practice address
8406 Six Forks Rd
Suite 204
Raleigh, NC 27615-3074
Phone
(919) 617-9656
Fax
(919) 617-9656
NPI assigned
Sep 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Stephanie Dawn Phillips, LCMHCSNPI 1225345689
Title
Owner
Phone
(919) 617-9656

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 8809 NC
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X C007721 NC
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

8406 Six Forks Rd
Suite 204
Raleigh, NC 27615-3074

Mailing address

8406 Six Forks Rd
Suite 204
Raleigh, NC 27615-3074
Phone (919) 617-9656

Other identifiers 1

IdentifierTypeStateIssuer
6008821MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140317000413 NC Part B Supplier - Clinic/Group Practice 3072744028 Receives reassigned benefits from 14 practitioners
Practice locations: Cary, NC; Durham, NC; Raleigh, NC

National Provider Directory

National Provider Directory

Locations

501 Keisler Dr
Ste 104
Cary, NC 27518
Phone (919) 617-9656

5611 NC Highway 55
Ste 103
Durham, NC 27713
Phone (919) 617-9656

8406 Six Forks Rd
Ste 201
Raleigh, NC 27615
Phone (919) 617-9656

312 W Millbrook Rd
Ste 233
Raleigh, NC 27609
Phone 9196179556101

8406 Six Forks Rd
Ste 204
Raleigh, NC 27615
Phone (919) 617-9656

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1306196944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8406 SIX FORKS RD",
            "address_2": "SUITE 204",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153074",
            "telephone_number": "919-617-9656",
            "fax_number": "919-617-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8406 SIX FORKS RD",
            "address_2": "SUITE 204",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153074",
            "telephone_number": "919-617-9656",
            "fax_number": "919-617-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDLY GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-617-9656",
        "authorized_official_credential": "LCMHCS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "8809",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C007721",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008821",
            "state": "NC"
        }
    ],
    "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 Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.