MEDICARE: MANIFESTED WELLNESS THERAPEUTIC SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1861172348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANIFESTED WELLNESS THERAPEUTIC SERVICES INC

Provider Business Mailing Address
First Line	:	2451 CUMBERLAND PKWY SE STE 3423
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6136
Country	:	US
Telephone Number	:	678-631-6053
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 WINDY HILL RD SE STE 210
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8644
Country	:	US
Telephone Number	:	678-631-6053
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADRIENNE WARREN
Credential	:
Telephone Number	:	678-631-6053

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	03/17/2026

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