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General NPI Number Information
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NPI Number | 1841550993
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Entity Type | Organization
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Legal Business Name | MINDCARE, LLC
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 9991 COMMERCE ST.
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City | SUMMERVILLE
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State | GA
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Zip | 30747
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Country | US
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Telephone | 404-556-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 7886 DRY CREEK RD
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City | SUMMERVILLE
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State | GA
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Zip | 30747-6851
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Country | US
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Telephone | 678-876-7554
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | DR. MAGDANA PHILOSSAINT
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Credential | PHD
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Telephone | 678-826-7554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CSW004690
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License Number State | GA
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