Provider Demographics
NPI:1982354395
Name:MINDFUL HEALTH SOLUTIONS GA PC
Entity Type:Organization
Organization Name:MINDFUL HEALTH SOLUTIONS GA PC
Other - Org Name:MINDFUL HEALTH SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-636-6955
Mailing Address - Street 1:360 POST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4908
Mailing Address - Country:US
Mailing Address - Phone:844-867-8444
Mailing Address - Fax:
Practice Address - Street 1:470 N SESSIONS ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1326
Practice Address - Country:US
Practice Address - Phone:844-867-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty