Healthcare Provider Details

I. General information

NPI: 1801274311
Provider Name (Legal Business Name): MINDFUL MATTERS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 MACON RD STE 27
COLUMBUS GA
31907-0707
US

IV. Provider business mailing address

6909 MACON RD STE 27
COLUMBUS GA
31907-0707
US

V. Phone/Fax

Practice location:
  • Phone: 706-888-3330
  • Fax:
Mailing address:
  • Phone: 762-400-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC008401
License Number StateGA

VIII. Authorized Official

Name: TENIKA TURNER
Title or Position: OWNER
Credential:
Phone: 762-400-2055