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General NPI Number Information
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NPI Number | 1568981686
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Entity Type | Organization
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Legal Business Name | THE MINDFUL WAY COUNSELING
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 7065 WESSEX WAY
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City | CUMMING
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State | GA
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Zip | 30028-5964
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Country | US
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Telephone | 229-220-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 7065 WESSEX WAY
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City | CUMMING
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State | GA
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Zip | 30028-5964
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Country | US
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Telephone | 229-220-7812
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERMY CHAD MERRITT
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Credential | LPC
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Telephone | 229-220-7812
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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 | LPC007658
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License Number State | GA
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