Vital Minds Psychotherapy & Life Coaching, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

VITAL MINDS PSYCHOTHERAPY & LIFE COACHING, LLC

Practice address

118 Hidden Dr
Blackwood, NJ 08012-4430

Phone

(609) 254-6213

NPI assigned

Feb 19, 2024

Last updated

Feb 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Quenise Harrison, LCSW

Title

Owner

Phone

(609) 254-6213

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1467217570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "288 EGG HARBOR RD STE 9",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080803131",
            "telephone_number": "609-254-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 HIDDEN DR",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080124430",
            "telephone_number": "609-254-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL MINDS PSYCHOTHERAPY & LIFE COACHING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "QUENISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-254-6213",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Blackwood, NJ
• Providers in Blackwood, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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.