Provider Demographics
NPI:1811537558
Name:MINDFUL THERAPY WORKS, LLC
Entity Type:Organization
Organization Name:MINDFUL THERAPY WORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-862-1735
Mailing Address - Street 1:2900 PACES FERRY RD SE STE C2000
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5730
Mailing Address - Country:US
Mailing Address - Phone:770-862-1735
Mailing Address - Fax:470-235-4663
Practice Address - Street 1:2900 PACES FERRY RD SE STE C2000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5730
Practice Address - Country:US
Practice Address - Phone:770-862-1735
Practice Address - Fax:470-235-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty