Healthcare Provider Details

I. General information

NPI: 1982354395
Provider Name (Legal Business Name): MINDFUL HEALTH SOLUTIONS GA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 N SESSIONS ST NW
MARIETTA GA
30060-1326
US

IV. Provider business mailing address

360 POST ST STE 500
SAN FRANCISCO CA
94108-4908
US

V. Phone/Fax

Practice location:
  • Phone: 844-867-8444
  • Fax:
Mailing address:
  • Phone: 844-867-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONIA CLARK
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 415-636-6955