Healthcare Provider Details

I. General information

NPI: 1275104291
Provider Name (Legal Business Name): AUTHENTIC MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BILL KENNEDY WAY SE APT 371
ATLANTA GA
30316-7242
US

IV. Provider business mailing address

230 BILL KENNEDY WAY SE APT 371
ATLANTA GA
30316-7242
US

V. Phone/Fax

Practice location:
  • Phone: 601-698-4172
  • Fax:
Mailing address:
  • Phone: 601-698-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ETTA KEMYATA BROWN
Title or Position: CLINICIAN
Credential: LPC
Phone: 601-698-4172