Healthcare Provider Details

I. General information

NPI: 1225951148
Provider Name (Legal Business Name): VAVEL MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 DASHEILL LN
ATLANTA GA
30349-1728
US

IV. Provider business mailing address

512 DASHEILL LN
ATLANTA GA
30349-1728
US

V. Phone/Fax

Practice location:
  • Phone: 732-710-8152
  • Fax:
Mailing address:
  • Phone: 732-710-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA BOLLERS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 732-710-8152