Healthcare Provider Details

I. General information

NPI: 1174196885
Provider Name (Legal Business Name): DLWELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 CENTURY BLVD NE
ATLANTA GA
30345-3398
US

IV. Provider business mailing address

1778 CENTURY BLVD NE
ATLANTA GA
30345-3398
US

V. Phone/Fax

Practice location:
  • Phone: 646-481-6126
  • Fax:
Mailing address:
  • Phone: 646-481-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DATONG LIU
Title or Position: THERAPIST/CEO
Credential: LCSW, SEP
Phone: 646-481-6126