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General NPI Number Information
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NPI Number | 1205188554
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Entity Type | Organization
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Legal Business Name | MINDFUL PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 288 S MAIN ST STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30009-1944
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Country | US
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Telephone | 678-775-8399
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Fax | 770-234-5889
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Provider Business Mailing Address
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Address Line | 288 S MAIN ST STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30009-1944
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Country | US
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Telephone | 678-775-8399
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Fax | 770-234-5889
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ERICA BARNES
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Credential | PSY.D.
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Telephone | 678-775-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3587
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License Number State | GA
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