Provider Demographics
NPI:1053164822
Name:MINDFUL INTENTIONS, PLLC
Entity type:Organization
Organization Name:MINDFUL INTENTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-861-9020
Mailing Address - Street 1:14316 REESE BLVD W STE B-690
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7959
Mailing Address - Country:US
Mailing Address - Phone:704-861-9020
Mailing Address - Fax:
Practice Address - Street 1:14316 REESE BLVD W STE B-690
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7959
Practice Address - Country:US
Practice Address - Phone:704-861-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health