Healthcare Provider Details

I. General information

NPI: 1245083179
Provider Name (Legal Business Name): ONETHREE WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E PONCE DE LEON AVE STE 120
DECATUR GA
30030-3412
US

IV. Provider business mailing address

3176 WARRENTON CT
DOUGLASVILLE GA
30135-1395
US

V. Phone/Fax

Practice location:
  • Phone: 770-835-5103
  • Fax:
Mailing address:
  • Phone: 770-835-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. SIERRA HILLSMAN
Title or Position: CEO
Credential: LPC
Phone: 770-835-5103