Organization
MINDFUL BEHAVIORAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AKILA PROCTOR (OWNER)
(919) 697-0767
Entity
Organization
Contact information
Practice address
2712 MIDDLEBURG DR, SUITE 105, COLUMBIA, SC 29204-2415
(803) 569-1789
(803) 462-4972
Mailing address
2712 MIDDLEBURG DR, SUITE 105, COLUMBIA, SC 29204-2415
(803) 569-1789
(803) 462-4972
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5981
—
SC
Enumeration date
02/29/2012
Last updated
01/27/2016
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