Healthcare Provider Details

I. General information

NPI: 1235083379
Provider Name (Legal Business Name): TARA SEALS MBA, MAED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N HIGHLAND AVE NE STE 230-396
ATLANTA GA
30307-1936
US

IV. Provider business mailing address

245 N HIGHLAND AVE NE STE 230-396
ATLANTA GA
30307-1936
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-0471
  • Fax:
Mailing address:
  • Phone: 310-435-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: