Healthcare Provider Details

I. General information

NPI: 1235973488
Provider Name (Legal Business Name): PLAYHEALS-A THERAPEUTIC COUNSELING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 12/10/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 WESTON LN
TUCKER GA
30084-5503
US

IV. Provider business mailing address

1885 WESTON LN
TUCKER GA
30084-5503
US

V. Phone/Fax

Practice location:
  • Phone: 678-431-0064
  • Fax:
Mailing address:
  • Phone: 678-431-0064
  • 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 Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: DR. CHASSITY TODD
Title or Position: CEO
Credential: PHD, LPC, NCC, ACS
Phone: 678-431-0064