Provider Demographics
NPI:1184202764
Name:MIND MANAGEMENT COUNSELING LLC
Entity Type:Organization
Organization Name:MIND MANAGEMENT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:201-953-5740
Mailing Address - Street 1:500 WISTERIA BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7265
Mailing Address - Country:US
Mailing Address - Phone:201-953-5740
Mailing Address - Fax:
Practice Address - Street 1:500 WISTERIA BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7265
Practice Address - Country:US
Practice Address - Phone:201-953-5740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty