| The Mind Renewed Llc | |
|
299 Cooper Rd Ste A Loganville GA 30052-2579 | |
| (678) 643-6782 | |
| (678) 643-6782 |
| Full Name | The Mind Renewed Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 299 Cooper Rd Ste A, Loganville, Georgia |
| Authorized Official Name and Position | Stacy W Froelich (SOCIAL WORKER) |
| Authorized Official Contact | 6786436782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Mind Renewed Llc 3820 Village Main St Loganville GA 30052-8619 Ph: (678) 643-6782 | The Mind Renewed Llc 299 Cooper Rd Ste A Loganville GA 30052-2579 Ph: (678) 643-6782 |
| NPI Number | 1932616109 |
|---|---|
| Provider Enumeration Date | 01/09/2018 |
| Last Update Date | 01/09/2018 |
| Medicare PECOS PAC ID | 4688934698 |
|---|---|
| Medicare Enrollment ID | O20180213002194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932616109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CSW006215 (Georgia) | Primary |
| Provider Name | Stacy Wolfe Froelich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033539093 PECOS PAC ID: 0648530659 Enrollment ID: I20180213002436 |
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