Creative Minds For Wellness, LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Loganville, GA. Organization (NPI-2).
NPI number1669974887
StatusActive
Last updated in NPPESMar 3, 2018
Details
- NPI
- 1669974887
- Entity type
- Organization (NPI-2)
- Legal business name
- Creative Minds For Wellness, LLC
- Organization subpart
- Yes
- Enumeration date
- Mar 3, 2018
- Last updated
- Mar 3, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | CSW004354 | GA | Yes |
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Practice location
125 Lee Byrd RdLoganville, GA 30052-2310
Phone 770-599-7512
Mailing address
4160 Logan Dr Unit 3261Loganville, GA 30052-9531
Phone 770-599-7512
Authorized official
Mandy Michelle Miller
Coo
9122007608
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