Healthcare Provider Details

I. General information

NPI: 1073335519
Provider Name (Legal Business Name): MOTHER HEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 ROSWELL RD STE G
ATLANTA GA
30328-3152
US

IV. Provider business mailing address

6595 ROSWLELL RD STE G PMB 4190
ATLANTA GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 470-242-1235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MONIQUE LATOYA HAWTHORNE
Title or Position: CO-FOUNDER
Credential: PSYD
Phone: 914-815-2848