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Organization
COOL MINDS GROUP, LLC
Active
Organization
COOL MINDS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORA STOREY JOHNSON M.D. (PRESIDENT/ CHIEF EXECUTIVE OFFICER)
(404) 699-9600
Entity
Organization
Contact information
Practice address
950 DANNON VW SW, SUITE 4102, ATLANTA, GA 30331-2160
(404) 699-9600
(404) 696-7100
Mailing address
950 DANNON VW SW, SUITE 4102, ATLANTA, GA 30331-2160
(404) 699-9600
(404) 696-7100
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
043071
GA
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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