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Organization
MINDFUL SPORT AND PERFORMANCE
Active
Organization
MINDFUL SPORT AND PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHENA F LOCKE LAPC (CEO)
(404) 783-8135
Entity
Organization
Contact information
Practice address
401 S MAIN ST, ALPHARETTA, GA 30009-1974
(404) 783-8135
Mailing address
401 S MAIN ST, ALPHARETTA, GA 30009-1974
(404) 783-8135
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Enumeration date
09/08/2020
Last updated
09/08/2020
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