Provider Demographics
NPI:1457690760
Name:MINDFUL ALTERNATIVES, INC.
Entity type:Organization
Organization Name:MINDFUL ALTERNATIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAE
Authorized Official - Middle Name:SANSOM
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-884-4011
Mailing Address - Street 1:370 LANIER AVE E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2237
Mailing Address - Country:US
Mailing Address - Phone:678-884-4011
Mailing Address - Fax:678-263-8511
Practice Address - Street 1:370 LANIER AVE E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2237
Practice Address - Country:US
Practice Address - Phone:678-884-4011
Practice Address - Fax:678-263-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty