Provider Demographics
NPI:1174029441
Name:STICKS IN A BUNDLE MENTORING & OUTREACH, LLC
Entity Type:Organization
Organization Name:STICKS IN A BUNDLE MENTORING & OUTREACH, LLC
Other - Org Name:STICKS IN A BUNDLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST/ COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAPC
Authorized Official - Phone:678-677-7735
Mailing Address - Street 1:2905 E POINT ST UNIT 90393
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30364-8607
Mailing Address - Country:US
Mailing Address - Phone:678-677-7735
Mailing Address - Fax:
Practice Address - Street 1:1865 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3526
Practice Address - Country:US
Practice Address - Phone:404-635-6021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC0006326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty