Provider Demographics
NPI:1336639640
Name:ABC MIND CENTER, LLC
Entity Type:Organization
Organization Name:ABC MIND CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NATES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-205-8175
Mailing Address - Street 1:3000 SW 3RD AVE APT 813
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2782
Mailing Address - Country:US
Mailing Address - Phone:305-205-8175
Mailing Address - Fax:
Practice Address - Street 1:3000 SW 3RD AVE APT 813
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2782
Practice Address - Country:US
Practice Address - Phone:305-205-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11716103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty