Healthcare Provider Details

I. General information

NPI: 1225955644
Provider Name (Legal Business Name): MAYO THERAPEUTIC INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 BETHELVIEW DR STE 500
CUMMING GA
30040-6913
US

IV. Provider business mailing address

2620 BETHELVIEW DR STE 500
CUMMING GA
30040-6913
US

V. Phone/Fax

Practice location:
  • Phone: 770-653-4531
  • Fax:
Mailing address:
  • Phone:
  • 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: AMANDA MAYO
Title or Position: OWNER/ PRIMARY PRACTITIONER
Credential: LPC
Phone: 770-653-4531