Provider Demographics
NPI:1396568911
Name:GREEN MIND BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:GREEN MIND BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-766-3003
Mailing Address - Street 1:5385 FIVE FORKS TRICKUM RD STE F
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3018
Mailing Address - Country:US
Mailing Address - Phone:770-766-3003
Mailing Address - Fax:770-599-5966
Practice Address - Street 1:5385 FIVE FORKS TRICKUM RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3018
Practice Address - Country:US
Practice Address - Phone:770-766-3003
Practice Address - Fax:770-599-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty