Provider Demographics
NPI:1891439717
Name:MINEHART, MIKAYLA (APC, NCC)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:MINEHART
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 BRISTOL TRCE
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8047
Mailing Address - Country:US
Mailing Address - Phone:260-920-4576
Mailing Address - Fax:
Practice Address - Street 1:5755 N POINT PKWY STE 280
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1176
Practice Address - Country:US
Practice Address - Phone:678-667-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health