Provider Demographics
NPI:1831978162
Name:SOLID MIND THERAPY, PLLC
Entity type:Organization
Organization Name:SOLID MIND THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, NCC
Authorized Official - Phone:404-234-9635
Mailing Address - Street 1:10211 BROKERS TIP LN APT 305
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6219
Mailing Address - Country:US
Mailing Address - Phone:404-234-9635
Mailing Address - Fax:
Practice Address - Street 1:10211 BROKERS TIP LN APT 305
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6219
Practice Address - Country:US
Practice Address - Phone:404-234-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty