Organization
THE MIND SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BIANCA FERGUSON PMHNP (NURSE PRACTITIONER)
(678) 216-7151
Entity
Organization
Contact information
Practice address
113 S PERRY ST STE 206, LAWRENCEVILLE, GA 30046-4811
(678) 216-7151
Mailing address
113 S PERRY ST STE 206, LAWRENCEVILLE, GA 30046-4811
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/21/2025
Last updated
11/21/2025
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