Healthcare Provider Details

I. General information

NPI: 1447000211
Provider Name (Legal Business Name): HEALING 2 WHOLENESS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 GLENEAGLE TRCE NW
CONYERS GA
30012-3304
US

IV. Provider business mailing address

2310 GLENEAGLE TRCE NW
CONYERS GA
30012-3304
US

V. Phone/Fax

Practice location:
  • Phone: 678-328-8919
  • Fax:
Mailing address:
  • Phone: 678-328-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. HERNEL L SELMAN
Title or Position: CEO/OWENER
Credential: EDD
Phone: 678-328-8919