Minddevelopers Counseling & Supervision PC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MINDDEVELOPERS COUNSELING & SUPERVISION PC

Practice address

6750 Clearstream Way
Austell, GA 30168-6719

Phone

(229) 942-1318

NPI assigned

Jan 1, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Shannon Renard Wilkerson, EDDNPI 1518331362

Title

Ceo/Clinical Therapist & Supervisor

Phone

(229) 942-1318

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Renard Wilkerson, EDD

  • Mental Health Counselor
  • Douglasville, GA
  • NPI 1518331362

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1704067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704067200000",
    "number": "1629847660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5284 FLOYD RD SW UNIT 1308",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301266113",
            "telephone_number": "229-942-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 CLEARSTREAM WAY",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301686719",
            "telephone_number": "229-942-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDDEVELOPERS COUNSELING & SUPERVISION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-01",
        "last_updated": "2024-01-01",
        "certification_date": "2023-12-30",
        "status": "A",
        "authorized_official_last_name": "WILKERSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "RENARD",
        "authorized_official_title_or_position": "CEO/CLINICAL THERAPIST & SUPERVISOR",
        "authorized_official_telephone_number": "229-942-1318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alana K Miller-Clayton
• Chad Miller, MD
• Michael S. Miller, DPM
• Wesley Miller, DO
• Jerakhine N Mills, FNP
• Omer M Mirza, MD
• Prashant Mishra, MD
• Taylor Mitchell, RDN, LDN
• Bashayer Mohammed, MD
• Elahe Mohazab

• Mental Health Counselor in Austell, GA
• Providers in Austell, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; 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.