Healthcare Provider Details

I. General information

NPI: 1174443717
Provider Name (Legal Business Name): HEALING BEYOND ALL EXPERIENCES COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W COURT SQ STE 750
DECATUR GA
30030-2545
US

IV. Provider business mailing address

1879 BROADWAY ST
DECATUR GA
30035-2243
US

V. Phone/Fax

Practice location:
  • Phone: 404-706-9077
  • Fax:
Mailing address:
  • Phone: 404-706-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS BREANNA OUILANNI ROBERTS
Title or Position: COUNSELOR/THERAPIST
Credential: LPC, NCC
Phone: 404-706-9077