Healthcare Provider Details

I. General information

NPI: 1912791674
Provider Name (Legal Business Name): A HEALING MIND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BELMONT DR
CANTON GA
30115-5543
US

IV. Provider business mailing address

106 BELMONT DR
CANTON GA
30115-5543
US

V. Phone/Fax

Practice location:
  • Phone: 404-593-9348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN ADEGBOYE
Title or Position: PSYCHOTHERAPIST
Credential: LPC
Phone: 404-593-9348