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General NPI Number Information
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NPI Number | 1124784731
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Entity Type | Organization
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Legal Business Name | CONTEMPORARY HEALING SPACES, INC
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 691 JOHN WESLEY DOBBS AVE NE STE V146
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City | ATLANTA
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State | GA
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Zip | 30312-1690
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Country | US
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Telephone | 347-639-8380
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Fax |
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Provider Business Mailing Address
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Address Line | 691 JOHN WESLEY DOBBS AVE NE STE V146
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City | ATLANTA
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State | GA
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Zip | 30312-1690
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Country | US
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Telephone | 912-430-7880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE SIMONE MARCUS
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Credential | LCSW
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Telephone | 912-430-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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