Provider Demographics
NPI:1043040207
Name:MINDFUL IMPACT COUNSELING AND COACHING
Entity type:Organization
Organization Name:MINDFUL IMPACT COUNSELING AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS.
Authorized Official - Prefix:
Authorized Official - First Name:NIMOTA (REMI)
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-406-5251
Mailing Address - Street 1:118 OHIO AVE N STE A PMB 1052
Mailing Address - Street 2:PMB 1052
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:324 NW MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-9509
Practice Address - Country:US
Practice Address - Phone:386-406-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty