Mindmender Counseling Services, PLLC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

3977 Issued in NC

Legal business name

MINDMENDER COUNSELING SERVICES, PLLC

Practice address

19824 W Catawba Ave
Suite G-205
Cornelius, NC 28031-4046

Phone

(704) 892-1828

NPI assigned

Dec 5, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Colleen Mary Serreno, LPC, LCAS

Title

Owner

Phone

(704) 892-1828

Specialties & licenses 2

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1467720565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2067",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280312067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19824 W CATAWBA AVE",
            "address_2": "SUITE G-205",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314046",
            "telephone_number": "704-892-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDMENDER COUNSELING SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "SERRENO",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-892-1828",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, LCAS"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "NC",
            "license": "3977",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1132",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "56162",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102349",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2056553",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF NC",
            "identifier": "130WW",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL",
            "identifier": "369641",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mideo Health of North Carolina PLLC
• Blakely A Milam, PHARMD
• Andrea Howard Miller, M.S., ED.S., LCMHCS
• Melissa Miller
• Donna Mills, RN CASE MANAGER
• Ashley Mitchell
• Anna Mixon, RD
• Monarch
• Gregory A Moon, MA, NCC, LCAS, LPC
• Kyley Moore

• Counselor in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.