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General NPI Number Information
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NPI Number | 1124678099
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Entity Type | Organization
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Legal Business Name | INTEGRATED MINDSETS INC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 3860 WINDERMERE PKWY STE 203
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City | CUMMING
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State | GA
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Zip | 30041-7034
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Country | US
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Telephone | 770-953-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 1827 POWERS FERRY RD SE BLDG 22
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City | ATLANTA
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State | GA
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Zip | 30339-5621
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Country | US
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Telephone | 770-953-4744
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAURISA BRODSKY VERSEL
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Credential | LPC
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Telephone | 770-953-4744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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