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General NPI Number Information
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NPI Number | 1598620585
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Entity Type | Organization
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Legal Business Name | MENDING MINDS THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 126 DENVER YORK LN
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City | TIGER
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State | GA
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Zip | 30576-1995
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Country | US
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Telephone | 706-490-3932
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Fax |
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Provider Business Mailing Address
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Address Line | 126 DENVER YORK LN
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City | TIGER
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State | GA
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Zip | 30576-1995
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Country | US
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Telephone | 706-490-3932
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Fax |
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Authorized Official
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Title or Position | LPC/OWNER
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Name | GEORGIA O'NEIL YOUNG
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Credential | LPC
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Telephone | 706-490-3932
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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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