Organization
MINDFUL BEHAVIORAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOMOYATTA AKILA PROCTOR (PRESIDENT)
(919) 697-0767
Entity
Organization
Contact information
Practice address
3255 LANDMARK DR, NORTH CHARLESTON, SC 29418-8461
(843) 864-1661
(843) 628-1020
Mailing address
3255 LANDMARK DR, NORTH CHARLESTON, SC 29418-8461
(843) 864-1661
(843) 628-1020
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
159 BHS
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159 BHS
—
SC
Enumeration date
06/02/2014
Last updated
06/02/2014
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