Healthcare Provider Details

I. General information

NPI: 1023913134
Provider Name (Legal Business Name): THE WELLNESS SHUFFLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 FAIRINGTON DR
LITHONIA GA
30038-5005
US

IV. Provider business mailing address

3211 FAIRINGTON DR
LITHONIA GA
30038-5005
US

V. Phone/Fax

Practice location:
  • Phone: 912-656-3958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TASHAYLA KEANDRA WILLIAMS
Title or Position: CO-OWNER, CLINICAL DIRECTOR
Credential: PHD, LPC, NCC
Phone: 912-656-3958