| Bodymind Therapeutics, Inc. | |
|
415 Dixie St Carrollton GA 30117-3921 | |
| (770) 838-9806 | |
| (770) 834-9188 |
| Full Name | Bodymind Therapeutics, Inc. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 415 Dixie St, Carrollton, Georgia |
| Authorized Official Name and Position | Theodore H Ceccoli (OWNER) |
| Authorized Official Contact | 7708389806 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bodymind Therapeutics, Inc. 8014 Longleaf Dr Villa Rica GA 30180-8666 Ph: (770) 838-9806 | Bodymind Therapeutics, Inc. 415 Dixie St Carrollton GA 30117-3921 Ph: (770) 838-9806 |
| NPI Number | 1427374024 |
|---|---|
| Provider Enumeration Date | 04/08/2010 |
| Last Update Date | 04/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427374024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC5686 (Georgia) | Primary |
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