Healthcare Provider Details

I. General information

NPI: 1013676535
Provider Name (Legal Business Name): PERSPECTIVES CENTER FOR HOLISTIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 MAIN ST
TUCKER GA
30084-4456
US

IV. Provider business mailing address

2370 MAIN ST
TUCKER GA
30084-4456
US

V. Phone/Fax

Practice location:
  • Phone: 770-634-3285
  • Fax:
Mailing address:
  • Phone: 770-634-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: STACEY WRIGHT
Title or Position: OPERATIONS DIRECTOR
Credential: NCC, APC, MBA
Phone: 404-227-0055