Healthcare Provider Details

I. General information

NPI: 1437743960
Provider Name (Legal Business Name): HOLISTIC COUNSELING AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 SALEM RD SE # 106-1048
CONYERS GA
30013-2097
US

IV. Provider business mailing address

2532 N DECATUR RD APT 1515
DECATUR GA
30033-6181
US

V. Phone/Fax

Practice location:
  • Phone: 404-974-6578
  • Fax:
Mailing address:
  • Phone: 404-974-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MORGAN
Title or Position: THERAPIST
Credential: LPC
Phone: 404-974-6578