Healthcare Provider Details

I. General information

NPI: 1265016356
Provider Name (Legal Business Name): SAPERE AUDE ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WOODMONT LN NW
ATLANTA GA
30318-2866
US

IV. Provider business mailing address

PO BOX 110280
ATLANTA GA
30311-9007
US

V. Phone/Fax

Practice location:
  • Phone: 404-333-8708
  • Fax: 404-420-2189
Mailing address:
  • Phone: 404-333-8708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLIE SHERMAN
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 404-333-8708