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General NPI Number Information
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NPI Number | 1104411453
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Entity Type | Organization
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Legal Business Name | A BEAUTIFUL MIND COUNSELING
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 711 ZITTEROUR DR
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City | RINCON
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State | GA
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Zip | 31326-9269
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Country | US
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Telephone | 912-480-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 70 SUNBURY CT
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City | RICHMOND HILL
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State | GA
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Zip | 31324-9621
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Country | US
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Telephone | 912-463-1542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE KOHL
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Credential | LCSW
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Telephone | 912-463-1542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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