Provider Demographics
NPI:1427694918
Name:COUNSELING, MINDFULNESS, & RECOVERY LLC
Entity type:Organization
Organization Name:COUNSELING, MINDFULNESS, & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-389-8143
Mailing Address - Street 1:267 ATLANTA AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2013
Mailing Address - Country:US
Mailing Address - Phone:928-231-9151
Mailing Address - Fax:
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 3000B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7280
Practice Address - Country:US
Practice Address - Phone:706-389-8143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty