Healthcare Provider Details

I. General information

NPI: 1801697495
Provider Name (Legal Business Name): THE WELLNESS WELL, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL # 4158
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL # 4158
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 404-585-8215
  • Fax:
Mailing address:
  • Phone: 404-585-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TATROYANA SMALLS
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 917-309-8080