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General NPI Number Information
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NPI Number | 1982403226
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Entity Type | Organization
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Legal Business Name | HONOR THY MIND LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 520 BRIGHTFIELD DRIVE
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone | 470-899-6852
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 DULUTH HWY STE F #3009
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 470-899-6852
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MARISA CLARKE
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Credential | NP
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Telephone | 470-899-6852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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