Provider Demographics
NPI:1770244709
Name:MATERNALLY MINDFUL COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:MATERNALLY MINDFUL COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-310-9216
Mailing Address - Street 1:225 REFORMATION PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2915
Mailing Address - Country:US
Mailing Address - Phone:678-310-9216
Mailing Address - Fax:
Practice Address - Street 1:225 REFORMATION PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2915
Practice Address - Country:US
Practice Address - Phone:678-310-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)