Provider Demographics
NPI:1336651272
Name:PRECIOUS MINDS COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:PRECIOUS MINDS COUNSELING & CONSULTING, LLC
Other - Org Name:PRECIOUS MINDS COUNSELING & CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:678-755-3443
Mailing Address - Street 1:2462 HUGHES CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331
Mailing Address - Country:US
Mailing Address - Phone:678-755-3443
Mailing Address - Fax:404-883-2210
Practice Address - Street 1:2920 MACON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3034
Practice Address - Country:US
Practice Address - Phone:706-507-3141
Practice Address - Fax:706-993-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136859AMedicaid