Healthcare Provider Details

I. General information

NPI: 1922566553
Provider Name (Legal Business Name): THE INSTITUTE FOR RELATIONSHIP WELLNESS & SEXUAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CUMBERLAND PKWY SE BLDG 500-140
ATLANTA GA
30339-4524
US

IV. Provider business mailing address

2790 SKYPARK DR STE 307
TORRANCE CA
90505-5388
US

V. Phone/Fax

Practice location:
  • Phone: 855-878-5325
  • Fax:
Mailing address:
  • Phone: 855-878-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MESHA ELLIS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 678-538-6450