Healthcare Provider Details

I. General information

NPI: 1053248211
Provider Name (Legal Business Name): VIDA COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N SELVIDGE ST STE 302
DALTON GA
30720-3101
US

IV. Provider business mailing address

801 CHATTANOOGA AVE APT A300
DALTON GA
30720-8887
US

V. Phone/Fax

Practice location:
  • Phone: 706-280-3214
  • Fax:
Mailing address:
  • Phone: 706-280-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEISHA MARIE HERNANDEZ
Title or Position: OWNER/THERPAIST
Credential: LPC
Phone: 706-280-3214