Basic Information
| Provider Information | |||||||||
| NPI: | 1396262085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING MINDS THERAPEUTIC SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5524 BEAR CREEK CIR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104890429 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4140 RAMSEY ST STE 108 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283117658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105809346 | ||||||||
| FaxNumber: | 9102293622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2017 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | JOHNNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9104890429 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LPC, LCAS | ||||||||
| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2305 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 9092 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.