Organization
MIND BODY SPLENDID SUN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHEAL LEE (MANAGER CREDENTIALING)
(786) 791-7529
Entity
Organization
Contact information
Practice address
185 MONTREAL WAY, FALLING WATERS, WV 25419-0109
(681) 242-3799
Mailing address
100 MIDDLETOWN PKWY UNIT 202, MIDDLETOWN, MD 21769-7767
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/22/2025
Last updated
02/02/2025
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