Provider Demographics
NPI:1023682325
Name:MIND & MANE PLLC
Entity type:Organization
Organization Name:MIND & MANE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA, LCASA
Authorized Official - Phone:443-538-7275
Mailing Address - Street 1:3664 GENESIS LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6088
Mailing Address - Country:US
Mailing Address - Phone:443-538-7275
Mailing Address - Fax:
Practice Address - Street 1:3664 GENESIS LN
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6088
Practice Address - Country:US
Practice Address - Phone:443-538-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty