=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639965379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESILIENT MINDS BEHAVIORAL HEALTH AND WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2025
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2230 TOWNE LAKE PKWY BUILDING 1000, STE. 130
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30189-5584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-644-0997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2230 TOWNE LAKE PKWY BUILDING 1000, STE. 130
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30189-5584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-644-0997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | KELLYE MARIE MILLS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 678-481-3315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------