Provider Demographics
NPI:1104411453
Name:A BEAUTIFUL MIND COUNSELING
Entity type:Organization
Organization Name:A BEAUTIFUL MIND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-463-1542
Mailing Address - Street 1:70 SUNBURY CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-9621
Mailing Address - Country:US
Mailing Address - Phone:912-463-1542
Mailing Address - Fax:
Practice Address - Street 1:711 ZITTEROUR DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9269
Practice Address - Country:US
Practice Address - Phone:912-480-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty