Healthcare Provider Details

I. General information

NPI: 1275350134
Provider Name (Legal Business Name): ALEXANDER & RUSHIN HOLISTIC MENTAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

IV. Provider business mailing address

4412 GLADEWOOD RUN
UNION CITY GA
30291-1148
US

V. Phone/Fax

Practice location:
  • Phone: 678-744-9978
  • Fax:
Mailing address:
  • Phone: 404-438-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICE ALEXANDER
Title or Position: FOUNDER/CEO
Credential: LPC, CPCS, MAC
Phone: 404-438-7736