Healthcare Provider Details

I. General information

NPI: 1932031630
Provider Name (Legal Business Name): ASPIRE WELLNESS OF EAST COBB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY RD BUILDING 21 SUITE 200
MARIETTA GA
30067
US

IV. Provider business mailing address

1640 POWERS FERRY RD SE BLD 21 SUITE 200
MARIETTA GA
30067
US

V. Phone/Fax

Practice location:
  • Phone: 678-540-4757
  • Fax:
Mailing address:
  • Phone: 678-540-4757
  • 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: DR. CHARLES DANIEL ALLEN III
Title or Position: OWNER
Credential: PSY.D.
Phone: 404-824-3330