Provider Demographics
NPI:1548615917
Name:MIRROR 2 THE HEART, PLLC
Entity type:Organization
Organization Name:MIRROR 2 THE HEART, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICHOL
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:980-859-3331
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS # 178
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:980-859-3331
Mailing Address - Fax:888-730-1933
Practice Address - Street 1:4311 SCHOOL HOUSE CMNS # 178
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7510
Practice Address - Country:US
Practice Address - Phone:980-859-3331
Practice Address - Fax:888-730-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10549101Y00000X, 101YM0800X, 101YP2500X
101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689097701Medicaid
NC1689097701Medicaid