Healthcare Provider Details

I. General information

NPI: 1164343455
Provider Name (Legal Business Name): MINDY CLARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 17TH ST NW UNIT 2903
ATLANTA GA
30363-1260
US

IV. Provider business mailing address

270 17TH ST NW UNIT 2903
ATLANTA GA
30363-1260
US

V. Phone/Fax

Practice location:
  • Phone: 423-902-3971
  • Fax:
Mailing address:
  • Phone: 423-902-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELINDA CLARK
Title or Position: OWNER
Credential: LPC
Phone: 423-902-3971