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Organization
MINDFUL MENTALITY, LLC
Active
Organization
MINDFUL MENTALITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE ANNE NORTHINGTON-REISSMAN PHD, QBA (OWNER AND PSYCHOLOGIST)
(630) 926-0577
Entity
Organization
Contact information
Practice address
3633 WHEELER RD STE 320, AUGUSTA, GA 30909-6552
(068) 423-2797
Mailing address
1204 STONE MEADOWS CT, GROVETOWN, GA 30813-5943
(630) 926-0577
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346811775
NPI
GA
01
—
1457632150
NPI
GA
01
—
1528639952
NPI
GA
01
—
15488319602
NPI
GA
Enumeration date
10/26/2022
Last updated
10/26/2022
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