Provider Demographics
NPI:1114536372
Name:THE MINDFUL MATCH, LLC
Entity Type:Organization
Organization Name:THE MINDFUL MATCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-913-3989
Mailing Address - Street 1:528B ANGIER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2902
Mailing Address - Country:US
Mailing Address - Phone:404-913-3989
Mailing Address - Fax:
Practice Address - Street 1:528B ANGIER AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2902
Practice Address - Country:US
Practice Address - Phone:404-913-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health