| Mindful Realizations Counseling & Consulting Llc | |
|
901 Pavilion Ct Mcdonough GA 30253-6665 | |
| (678) 814-4375 | |
| (770) 995-1959 |
| Full Name | Mindful Realizations Counseling & Consulting Llc |
|---|---|
| Speciality | Counselor |
| Location | 901 Pavilion Ct, Mcdonough, Georgia |
| Authorized Official Name and Position | Tiffany Lynn Sullivan (OWNER) |
| Authorized Official Contact | 6788144375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Realizations Counseling & Consulting Llc 901 Pavilion Ct Mcdonough GA 30253-6665 Ph: (678) 814-4375 | Mindful Realizations Counseling & Consulting Llc 901 Pavilion Ct Mcdonough GA 30253-6665 Ph: (678) 814-4375 |
| NPI Number | 1295164549 |
|---|---|
| Provider Enumeration Date | 11/07/2013 |
| Last Update Date | 11/04/2023 |
| Certification Date | 11/04/2023 |
| Medicare PECOS PAC ID | 6507202546 |
|---|---|
| Medicare Enrollment ID | O20240312003363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295164549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC007416 (Georgia) | Primary |
| Provider Name | John Sullivan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275249112 PECOS PAC ID: 2264889914 Enrollment ID: I20231117000295 |
| Provider Name | Tiffany Sullivan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093061285 PECOS PAC ID: 9133565179 Enrollment ID: I20240411002812 |
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