Mental Space LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MENTAL SPACE LLC

Practice address

4408 Columbia Rd Ste 104
Martinez, GA 30907-4561

Phone

(707) 819-1390

NPI assigned

Dec 10, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Stringfield

Title

Owner

Phone

(706) 619-1390

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1295372225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44163",
            "city": "GOODFELLOW AFB",
            "state": "TX",
            "postal_code": "769080163",
            "telephone_number": "706-619-1390",
            "fax_number": "505-370-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4408 COLUMBIA RD STE 104",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309074561",
            "telephone_number": "707-819-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL SPACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-10",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A",
        "authorized_official_last_name": "STRINGFIELD",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-619-1390"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Zondra Rashell Mele, LPC
• Ana Maria Melendez, LMT
• Johanna Mendez
• Anupama A Mikkilineni, RPH
• Fredicia Miles
• Donovan Emmanuel Allen Miller
• Kelley Miller, FNP-C
• Rashaka Miller

• Mental Health Clinic/Center (Including Community Mental Health Center) in Martinez, GA
• Providers in Martinez, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.