Mindful Behavioral

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

159 BHS Issued in SC

Legal business name

MINDFUL BEHAVIORAL

Practice address

3255 Landmark Dr
North Charleston, SC 29418-8461

Phone

(843) 864-1661

Fax

(843) 628-1020

NPI assigned

Jun 2, 2014

Last updated

Jun 2, 2014By 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

Mr. Jomoyatta Akila Proctor

Title

President

Phone

(919) 697-0767

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Mindful Behavioral2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mindful Behavioral, Inc

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1811236342
  NPD tax ID

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1891108320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 LANDMARK DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294188461",
            "telephone_number": "843-864-1661",
            "fax_number": "843-628-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 LANDMARK DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294188461",
            "telephone_number": "843-864-1661",
            "fax_number": "843-628-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIORAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2014-06-02",
        "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": "159 BHS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159 BHS",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tierra Miller
• Alison W Mills, PHARMD
• Dorenda Mims
• Kevin Ray Mims, RN
• Mind Body Perspective LLC
• Mindfulnest Counseling and Wellness Center LLC
• George E Minson, M.D.
• Abigail Miskew
• Amy D Mitchell, OTR/L
• Marcie Hudgins Mitchell, PHARMD

• Community/Behavioral Health Agency in North Charleston, SC
• Providers in North Charleston, 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 Jun 2, 2014; 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.