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General NPI Number Information
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NPI Number | 1073273819
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Entity Type | Organization
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Legal Business Name | MIND AND BODY THERAPY GA, LLC
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 5000 HENSON DR. SE
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City | MABLETON
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State | GA
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Zip | 30126-3012
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Country | US
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Telephone | 404-919-0409
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 VETERANS MEMORIAL HWY SE STE 660 #3011
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City | MABLETON
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State | GA
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Zip | 30126-7711
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Country | US
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Telephone | 404-919-0409
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | ROBYN MINEFEE
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Credential | LPC
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Telephone | 678-349-4318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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