Provider Demographics
NPI:1144975111
Name:MANIFESTING GREATNESS THERAPY LLC
Entity type:Organization
Organization Name:MANIFESTING GREATNESS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:SHADAWN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:912-247-1178
Mailing Address - Street 1:4000 DUNWOODY PARK APT 5121
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7966
Mailing Address - Country:US
Mailing Address - Phone:470-890-2900
Mailing Address - Fax:
Practice Address - Street 1:4000 DUNWOODY PARK APT 5121
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7966
Practice Address - Country:US
Practice Address - Phone:470-890-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)