Healthcare Provider Details

I. General information

NPI: 1386550812
Provider Name (Legal Business Name): SEEDHOUSE COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 TALON DR SE
RYDAL GA
30171-1787
US

IV. Provider business mailing address

156 TALON DR SE
RYDAL GA
30171-1787
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-7204
  • Fax: 404-601-9692
Mailing address:
  • Phone: 404-851-7204
  • Fax: 404-601-9692

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: DR. TYLISAEA BONNER
Title or Position: OWNER
Credential: DSW, LCSW
Phone: 404-851-7204