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General NPI Number Information
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NPI Number | 1205619822
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Entity Type | Organization
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Legal Business Name | JAVERY INTEGRATIVE WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 06/15/2024
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Provider Practice Location Address
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Address Line | 2675 PACES FERRY RD SE STE 140
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City | ATLANTA
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State | GA
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Zip | 30339-4089
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Country | US
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Telephone | 470-601-6076
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Fax |
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Provider Business Mailing Address
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Address Line | 332 CHANDLER RDG
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City | MCDONOUGH
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State | GA
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Zip | 30253-8275
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATASHA RILEY
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Credential | LPC
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Telephone | 470-601-6076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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