Healthcare Provider Details

I. General information

NPI: 1447124367
Provider Name (Legal Business Name): RESILIENT MINDS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 AUSTELL RD STE 5
AUSTELL GA
30106-2007
US

IV. Provider business mailing address

4760 AUSTELL RD STE 5
AUSTELL GA
30106-2007
US

V. Phone/Fax

Practice location:
  • Phone: 404-919-0409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHIALLA WARREN
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 404-891-9117