Mind Body and Soul a Road to Recovery

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

MIND BODY AND SOUL A ROAD TO RECOVERY

Practice address

5490 Broadway BSMT
Merrillville, IN 46410-1675

Phone

(219) 555-5555

NPI assigned

Jun 2, 2021

Organization subpart

No

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

Authorized official

Name

Lynn McDonald

Title

Credentialing Specialist

Phone

(219) 769-1670

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Victoria Charleston, LCAC

  • Addiction (Substance Use Disorder) Counselor
  • Gary, IN
  • NPI 1366855462
  NPD (past)

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1366018129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5490 BROADWAY BSMT",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464101675",
            "telephone_number": "219-939-7763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5490 BROADWAY BSMT",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464101675",
            "telephone_number": "219-555-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY AND SOUL A ROAD TO RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "219-769-1670"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaunterreah Miller, FNP-C
• Yolanda Miller, RBT
• Kylie Anne Millhorn, RBT
• Evan John Milway, PHARMD
• Michael Hyukki Min, D.D.S.
• Alexander Minix, RBT
• Ellen Minter, LCSW
• Marcus Minued
• Mirich Medical Corporation
• Ernest C Mirich, MD

• Addiction (Substance Use Disorder) Counselor in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Addiction (Substance Use Disorder) Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.