1407358203 NPI number — MIND CHANGING SOLUTIONS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407358203 NPI number — MIND CHANGING SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIND CHANGING SOLUTIONS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407358203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26976
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28221-6976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-651-8514
Provider Business Mailing Address Fax Number:
704-595-7155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8929 J M KEYNES DR STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-875-9473
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MCFADDEN
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
OWNER / THERAPIST
Authorized Official Telephone Number:
704-651-8514

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  3283 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 11088 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 6407 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1407358203 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP8318 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225449044 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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