Healthcare Provider Details

I. General information

NPI: 1124310693
Provider Name (Legal Business Name): WHOLISTIC STRESS CONTROL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 BENJAMIN E MAYS DR SW
ATLANTA GA
30311-2450
US

IV. Provider business mailing address

2545 BENJAMIN E MAYS DR SW
ATLANTA GA
30311-2450
US

V. Phone/Fax

Practice location:
  • Phone: 404-707-0068
  • Fax: 404-755-4333
Mailing address:
  • Phone: 404-707-0068
  • Fax: 404-755-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC000390
License Number StateGA

VIII. Authorized Official

Name: JENNIE C TROTTER
Title or Position: EXECUTIVE DIRECTOR
Credential: M. ED, LPC
Phone: 404-755-0068