Provider Demographics
NPI:1578335618
Name:LYDIAS SMALL UNIQUE MINDS LLC
Entity Type:Organization
Organization Name:LYDIAS SMALL UNIQUE MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-883-5801
Mailing Address - Street 1:312 RENDER ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3418
Mailing Address - Country:US
Mailing Address - Phone:706-883-5801
Mailing Address - Fax:706-416-2490
Practice Address - Street 1:312 RENDER ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3418
Practice Address - Country:US
Practice Address - Phone:706-883-5801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health