MENTAL SPACE LLC (NPI# 1295372225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1295372225 |
Entity Type | Organization |
Organization Name | MENTAL SPACE LLC |
Practice Address |
4210 Columbia Rd Unit D Martinez GA 30907-0401 |
Mailing Address |
Po Box 1521 Harlem GA 30814-1521 |
Practice Telephone | 7066191390 |
Mailing Telephone | 7066191390 |
Mailing Fax Number | 5053704730 |
Enumeration Date | 2019-12-10 |
Last Update Date | 2019-12-10 |
Authorized Official Name | JESSICA STRINGFIELD (OWNER) |
Authorized Official Telephone | 7066191390 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
Street Address |
4210 COLUMBIA RD UNIT D |
City | MARTINEZ |
State | GA |
Zip Code | 30907-0401 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275158156 | Mary Cameron Elizabeth Robert | Dentist | 3226 Washington Rd, Augusta, GA 30907 | 2020-06-16 |
1841760451 | Debra E Gibbs | Dental Hygienist | 523 Crystal Creek West, Martinez, GA 30907 | 2018-11-27 |
1083183651 | Leslie Yvonne Watkins | Massage Therapist | 3450 River Watch Parkway, Suite 100, Martinez, GA 30907 | 2018-11-13 |
1124594718 | Kimberly A Delaigle | Nurse Practitioner | 3475 Riverwatch Parkway, Suite 310, Martinez, GA 30907 | 2018-10-22 |
1366960825 | Catherine Lane Hopkins | Speech-Language Pathologist | 435 Cambridge Circle, Martinez, GA 30907 | 2017-09-05 |
1518485143 | Challenging Perspectives | Clinic/Center | 3710 Executive Center Dr Suite B, Martinez, GA 30907 | 2017-09-04 |
1386168490 | Carlene Elizabeth Lemcke | Speech-Language Pathologist | 3580 Riverwatch Parkway, Martinez, GA 30907 | 2017-07-31 |
1619499357 | Orchid Archer | Registered Nurse | 702 Riverbend Drive, Martinez, GA 30907 | 2017-07-14 |
1437679339 | Mediator Senior Care, LLC | In Home Supportive Care | 4143 Columbia Rd., Suite B, Martinez, GA 30907 | 2017-06-21 |
1518407907 | Augusta Smilecare PC | Dentist | 4200 Columbia Road, Martinez, GA 30907 | 2017-03-03 |
Find all providers in zip 30907 |
Taxonomy Code | 261QM0801X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Mental Health (Including Community Mental Health Center) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124198700 | Contra Costa County | Clinic/Center | 202 Glacier Dr, Martinez, CA 94553-4826 | 2006-11-09 |
1639572522 | Andrea Nicole Griffin | Clinic/Center | 1210 Alhambra Ave, Martinez, CA 94553-2300 | 2014-10-06 |
1184761017 | Ywca of Contra Costa & Sacramento | Clinic/Center | 1320 Arnold Dr, Suite 170, Martinez, CA 94553-6537 | 2007-01-31 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.