Provider Demographics
NPI:1053179291
Name:MINDFULNEST COUNSELING AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MINDFULNEST COUNSELING AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-949-6031
Mailing Address - Street 1:6650 RIVERS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4809
Mailing Address - Country:US
Mailing Address - Phone:843-780-2944
Mailing Address - Fax:
Practice Address - Street 1:3265 N CAROLINA AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5825
Practice Address - Country:US
Practice Address - Phone:803-949-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health