Provider Demographics
NPI:1871771451
Name:A STATE OF MIND COUNSELING AND WELLNESS CENTERS INC
Entity type:Organization
Organization Name:A STATE OF MIND COUNSELING AND WELLNESS CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PECORARO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CBHT
Authorized Official - Phone:954-761-3869
Mailing Address - Street 1:915 MIDDLE RIVER DR
Mailing Address - Street 2:SUITE 317
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3544
Mailing Address - Country:US
Mailing Address - Phone:954-761-3869
Mailing Address - Fax:954-463-1687
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:SUITE 317
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:954-761-3869
Practice Address - Fax:954-463-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder