Organization
MINDFUL BEHAVIORAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AKILA PROCTOR (CEO)
(919) 697-0767
Entity
Organization
Contact information
Practice address
323 MERCY ST, LAKE CITY, SC 29560-2331
(843) 374-4494
(888) 974-8541
Mailing address
2712 MIDDLEBURG DR, SUITE 105, COLUMBIA, SC 29204-2415
(803) 569-1789
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
20152393
SC
Other
Enumeration date
07/30/2015
Last updated
01/27/2016
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