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General NPI Number Information
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NPI Number | 1366121550
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Entity Type | Organization
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Legal Business Name | CULTIVATING WELLNESS LLC.
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BUILDING 21, SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 678-540-1747
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 723882
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City | ATLANTA
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State | GA
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Zip | 31139-0882
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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 | THERAPIST
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Name | KEVIN MORTON
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Credential | LMFT
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Telephone | 678-540-1747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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