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General NPI Number Information
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NPI Number | 1659890929
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MINDFULNESS THERAPY, LLC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 2800 SCENIC DR STE 4-301
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4453
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Country | US
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Telephone | 404-566-7761
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 812
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City | MORGANTON
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State | GA
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Zip | 30560-0812
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Country | US
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Telephone | 404-566-7761
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MICHELLE NELSON
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Credential | LCSW
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Telephone | 404-561-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004103
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License Number State | GA
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