Provider Demographics
NPI:1740987122
Name:MIND IS UNIQUE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MIND IS UNIQUE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEANETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-456-5863
Mailing Address - Street 1:368 NORWOOD CAMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30821-5919
Mailing Address - Country:US
Mailing Address - Phone:478-456-5863
Mailing Address - Fax:
Practice Address - Street 1:368 NORWOOD CAMAK RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:GA
Practice Address - Zip Code:30821-5919
Practice Address - Country:US
Practice Address - Phone:478-456-5863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health