MEDICARE: CULTIVATING MINDS COUNSELING GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1215583885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULTIVATING MINDS COUNSELING GROUP, LLC

Provider Business Mailing Address
First Line	:	3430 MONTROSE AVE
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3371
Country	:	US
Telephone Number	:	256-312-0323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 3RD AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1628
Country	:	US
Telephone Number	:	205-872-1991
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CHARLOTTE JONES
Credential	:	ALC
Telephone Number	:	205-872-1991

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	08/09/2019

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