Organization
BODYMIND THERAPEUTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE H CECCOLI LPC (OWNER)
(770) 838-9806
Entity
Organization
Contact information
Practice address
415 DIXIE ST, CARROLLTON, GA 30117-3921
(770) 838-9806
(770) 834-9188
Mailing address
8014 LONGLEAF DR, VILLA RICA, GA 30180-8666
(770) 838-9806
(770) 834-9188
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC5686
GA
Other
Enumeration date
04/08/2010
Last updated
04/08/2010
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