Provider Demographics
NPI:1902423114
Name:MINDFUL ONE LLC
Entity Type:Organization
Organization Name:MINDFUL ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TANDON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-332-9095
Mailing Address - Street 1:5921 HALL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1402
Mailing Address - Country:US
Mailing Address - Phone:571-332-9095
Mailing Address - Fax:
Practice Address - Street 1:5921 HALL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1402
Practice Address - Country:US
Practice Address - Phone:571-332-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty