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General NPI Number Information
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NPI Number | 1730616798
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Entity Type | Organization
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Legal Business Name | THE MENTALISTS GROUP LLC
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Dates
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Enumeration Date | 05/20/2017
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Last Update Date | 05/20/2017
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Provider Practice Location Address
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Address Line | 124 S MAIN ST STE 2D
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City | JONESBORO
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State | GA
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Zip | 30236-3502
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Country | US
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Telephone | 404-664-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 124 S MAIN ST STE 2D
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City | JONESBORO
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State | GA
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Zip | 30236-3502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR / OWNER
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Name | MR. DARNELL PHILLIPS
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Credential | LPC
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Telephone | 615-414-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009363
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License Number State | GA
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