Provider Demographics
NPI:1093421737
Name:MINDFUL MENTAL HEALTH OF ALABAMA LLC
Entity Type:Organization
Organization Name:MINDFUL MENTAL HEALTH OF ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-536-8345
Mailing Address - Street 1:3100 GENTIAN BLVD STE 107I
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5641
Mailing Address - Country:US
Mailing Address - Phone:888-777-6945
Mailing Address - Fax:334-470-2121
Practice Address - Street 1:300 N DEAN RD STE 5-208
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4404
Practice Address - Country:US
Practice Address - Phone:888-777-6945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty