Provider Demographics
NPI:1598070096
Name:COOL MINDS GROUP, LLC
Entity Type:Organization
Organization Name:COOL MINDS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:STOREY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-699-9600
Mailing Address - Street 1:950 DANNON VW SW
Mailing Address - Street 2:SUITE 4102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2160
Mailing Address - Country:US
Mailing Address - Phone:404-699-9600
Mailing Address - Fax:404-696-7100
Practice Address - Street 1:950 DANNON VW SW
Practice Address - Street 2:SUITE 4102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2160
Practice Address - Country:US
Practice Address - Phone:404-699-9600
Practice Address - Fax:404-696-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X, 103TC2200X, 1041C0700X
GA0430712084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty