Healthcare Provider Details

I. General information

NPI: 1346036266
Provider Name (Legal Business Name): LOVING MY MENTAL STATE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 HIGHWAY 85 UNIT 102
RIVERDALE GA
30274-1502
US

IV. Provider business mailing address

925 MAIN ST STE 300-143
STONE MOUNTAIN GA
30083-3098
US

V. Phone/Fax

Practice location:
  • Phone: 678-476-3717
  • Fax: 404-745-0859
Mailing address:
  • Phone: 678-476-3717
  • Fax: 404-745-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. FELICIA A DANIEL
Title or Position: CEO
Credential:
Phone: 678-476-3717