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General NPI Number Information
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NPI Number | 1245876804
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Entity Type | Organization
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Legal Business Name | ENVISION WELLNESS LLC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 5887 GLENRIDGE DR STE 230
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-9929
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Country | US
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Telephone | 678-616-2435
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 E POINT ST # 640095
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City | EAST POINT
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State | GA
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Zip | 30344-4202
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Country | US
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Telephone | 704-281-3705
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAMECIA E EADDY
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Credential | LCSW
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Telephone | 704-281-3705
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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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