Provider Demographics
NPI:1841550993
Name:MINDCARE, LLC
Entity type:Organization
Organization Name:MINDCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILOSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-826-7554
Mailing Address - Street 1:7886 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-6851
Mailing Address - Country:US
Mailing Address - Phone:678-876-7554
Mailing Address - Fax:
Practice Address - Street 1:9991 COMMERCE ST.
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747
Practice Address - Country:US
Practice Address - Phone:404-556-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004690251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124139BMedicaid