Provider Demographics
NPI:1861263089
Name:MINDSHIFTERS SOLUTION LLC
Entity type:Organization
Organization Name:MINDSHIFTERS SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YULANDAR
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-824-9558
Mailing Address - Street 1:437 LAURENS AVE S
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827-5302
Mailing Address - Country:US
Mailing Address - Phone:803-824-9558
Mailing Address - Fax:
Practice Address - Street 1:437 LAURENS AVE S
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:SC
Practice Address - Zip Code:29827-5302
Practice Address - Country:US
Practice Address - Phone:803-824-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)