Provider Demographics
NPI:1689244170
Name:SELF-CARE MENTAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:SELF-CARE MENTAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD-THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:718-715-6993
Mailing Address - Street 1:205 BENEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-0965
Mailing Address - Country:US
Mailing Address - Phone:718-715-6993
Mailing Address - Fax:
Practice Address - Street 1:600 WESTRIDGE PKWY STE 714
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7789
Practice Address - Country:US
Practice Address - Phone:718-715-6993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty