Provider Demographics
NPI:1619660685
Name:MINDSET DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:MINDSET DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-510-9660
Mailing Address - Street 1:255 N MAIN ST UNIT 1355
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3298
Mailing Address - Country:US
Mailing Address - Phone:404-510-9660
Mailing Address - Fax:
Practice Address - Street 1:6726 TARA BLVD APT 15G
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1427
Practice Address - Country:US
Practice Address - Phone:404-510-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty