Provider Demographics
NPI:1528425717
Name:DECATUR MINDFULNESS AND PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:DECATUR MINDFULNESS AND PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, MSW, LCSW
Authorized Official - Phone:678-827-3456
Mailing Address - Street 1:321 W HILL ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4362
Mailing Address - Country:US
Mailing Address - Phone:678-827-3456
Mailing Address - Fax:678-669-2051
Practice Address - Street 1:321 W HILL ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4362
Practice Address - Country:US
Practice Address - Phone:678-827-3456
Practice Address - Fax:678-669-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty