MEDICARE: ASPIRING MINDZ LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1558112268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRING MINDZ LLC

Provider Business Mailing Address
First Line	:	155 WESTRIDGE PKWY STE 110
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-3050
Country	:	US
Telephone Number	:	470-682-3132
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WESTRIDGE PKWY STE 110
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-3050
Country	:	US
Telephone Number	:	470-682-3132
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. JENISE TEHVON GREENE
Credential	:	LPC
Telephone Number	:	470-682-3132

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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Directions to “ASPIRING MINDZ LLC ” Practice Location

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