Provider Demographics
NPI:1902957160
Name:MIMOSA CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:MIMOSA CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-433-5600
Mailing Address - Street 1:220 BURKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4454
Mailing Address - Country:US
Mailing Address - Phone:828-433-5600
Mailing Address - Fax:828-433-5656
Practice Address - Street 1:220 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4454
Practice Address - Country:US
Practice Address - Phone:828-433-5600
Practice Address - Fax:828-433-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3250101Y00000X
NC1549103T00000X
NC1907103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015X3OtherBCBSNC