Provider Demographics
NPI:1154741973
Name:MOMMIE AND ME ADVOCACY
Entity type:Organization
Organization Name:MOMMIE AND ME ADVOCACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:678-296-9492
Mailing Address - Street 1:5031 MONARCH DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8649
Mailing Address - Country:US
Mailing Address - Phone:770-648-3907
Mailing Address - Fax:770-818-5430
Practice Address - Street 1:5031 MONARCH DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8649
Practice Address - Country:US
Practice Address - Phone:770-648-3907
Practice Address - Fax:770-818-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-19
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty