Provider Demographics
NPI:1295164549
Name:MINDFUL REALIZATIONS COUNSELING & CONSULTING LLC
Entity type:Organization
Organization Name:MINDFUL REALIZATIONS COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-814-4375
Mailing Address - Street 1:901 PAVILION CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6665
Mailing Address - Country:US
Mailing Address - Phone:678-814-4375
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:901 PAVILION CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6665
Practice Address - Country:US
Practice Address - Phone:678-814-4375
Practice Address - Fax:770-995-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty