Healthcare Provider Details

I. General information

NPI: 1720906423
Provider Name (Legal Business Name): MH WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JR GRANT BLVD, APT 11104
MCDONOUGH GA
30253
US

IV. Provider business mailing address

1400 JR GRANT BLVD APT 11104
MCDONOUGH GA
30253-8437
US

V. Phone/Fax

Practice location:
  • Phone: 216-780-0059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA HOLT
Title or Position: OWNER
Credential: LCSW
Phone: 216-780-0059