Healthcare Provider Details

I. General information

NPI: 1053237909
Provider Name (Legal Business Name): MY MENTAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W TISBURY LN
POOLER GA
31322-8266
US

IV. Provider business mailing address

135 W TISBURY LN
POOLER GA
31322-8266
US

V. Phone/Fax

Practice location:
  • Phone: 912-388-0604
  • Fax: 770-995-1959
Mailing address:
  • Phone: 912-388-0604
  • Fax: 770-995-1959

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: ALISON JEDRICK
Title or Position: OWNER
Credential: LCSW
Phone: 912-388-0604