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Organization
MINDFUL CLINIC
Active
Organization
MINDFUL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AKILA PROCTOR (CEO)
(919) 697-0767
Entity
Organization
Contact information
Practice address
2712 MIDDLEBURG DR, SUITE 104, COLUMBIA, SC 29204-2415
(919) 697-0767
Mailing address
2712 MIDDLEBURG DR, SUITE 104, COLUMBIA, SC 29204-2415
(919) 697-0767
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/30/2015
Last updated
11/30/2015
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