Mindful Behavioral Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MINDFUL BEHAVIORAL INC

Practice address

210 W Harrison St
Dillon, SC 29536-3310

Phone

(843) 487-5004

Fax

(877) 343-3190

NPI assigned

Jun 10, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Jomoyatta Akila Proctor

Title

President

Phone

(919) 697-0767

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1881007573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 MIDDLEBURG DR",
            "address_2": "SUITE 105",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042415",
            "telephone_number": "803-569-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W HARRISON ST",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295363310",
            "telephone_number": "843-487-5004",
            "fax_number": "877-343-3190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIORAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-10",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "JOMOYATTA",
        "authorized_official_middle_name": "AKILA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-697-0767",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188BHS",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mamdouh N Mijalli, MD
• Sterling Miles
• Daniel Walter Miller, Jr, D.M.D.
• Olivia Price Miller
• Ridgill Long Mims, RN
• Benjamin T Mitchell III, MD
• Priscilla Blue Morrison, M.A.
• Rhonda Page Moxey
• Murphy Transport
• National Home Health Care Sercices, LLC

• Community/Behavioral Health Agency in Dillon, SC
• Providers in Dillon, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; 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.