Healthcare Provider Details

I. General information

NPI: 1871955781
Provider Name (Legal Business Name): ART OF THERAPY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4598 ASH TREE ST
SNELLVILLE GA
30039-3361
US

IV. Provider business mailing address

2140 MCGEE RD STE C140A
SNELLVILLE GA
30078-2975
US

V. Phone/Fax

Practice location:
  • Phone: 678-467-1479
  • Fax:
Mailing address:
  • Phone: 678-514-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC008862
License Number StateGA

VIII. Authorized Official

Name: JUANITA M BENTLEY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 770-856-7836