Provider Demographics
NPI:1669081543
Name:MANIFESTING MINDS, LLC
Entity type:Organization
Organization Name:MANIFESTING MINDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, MSN, PMHNP-BC
Authorized Official - Phone:470-336-0474
Mailing Address - Street 1:710 DACULA RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7014
Mailing Address - Country:US
Mailing Address - Phone:470-336-0474
Mailing Address - Fax:470-437-3209
Practice Address - Street 1:1092 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5012
Practice Address - Country:US
Practice Address - Phone:470-914-7600
Practice Address - Fax:470-437-3209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANIFESTING MINDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-28
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty