Healthcare Provider Details

I. General information

NPI: 1508771809
Provider Name (Legal Business Name): HOLISTIC HAVEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 PEACHTREE STREET NE
ATLANTA GA
30308
US

IV. Provider business mailing address

246 ROBERT C DANIEL JR PKWY # 1326
AUGUSTA GA
30909-0803
US

V. Phone/Fax

Practice location:
  • Phone: 678-536-3102
  • Fax:
Mailing address:
  • Phone: 678-536-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ATKINSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 678-536-3102