Provider Demographics
NPI:1235968371
Name:A MIX OF EMOTIONS LLC
Entity type:Organization
Organization Name:A MIX OF EMOTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-580-9956
Mailing Address - Street 1:9015 WOODYARD RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4209
Mailing Address - Country:US
Mailing Address - Phone:240-580-9956
Mailing Address - Fax:
Practice Address - Street 1:9015 WOODYARD RD STE 206
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4209
Practice Address - Country:US
Practice Address - Phone:240-580-9956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health