Healthcare Provider Details

I. General information

NPI: 1659890929
Provider Name (Legal Business Name): MOUNTAIN MINDFULNESS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 MORGANTON HWY UNIT 812
MORGANTON GA
30560-3296
US

IV. Provider business mailing address

PO BOX 812
MORGANTON GA
30560-0812
US

V. Phone/Fax

Practice location:
  • Phone: 404-566-7761
  • Fax:
Mailing address:
  • Phone: 404-566-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004103
License Number StateGA

VIII. Authorized Official

Name: MICHELLE NELSON
Title or Position: LCSW
Credential: LCSW
Phone: 404-566-7761