=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477419257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTAKE PSYCHOTHERAPY & WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2025
-----------------------------------------------------
Last Update Date | 12/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 HIGHWAY 34 E STE 7
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30265-2182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-988-3008
-----------------------------------------------------
Fax | 470-713-7668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1415 HIGHWAY 85 N STE 310-394
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-7738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-988-3008
-----------------------------------------------------
Fax | 470-713-7668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING MEMBER
-----------------------------------------------------
Name | BERTHA FREEMAN BARRETT
-----------------------------------------------------
Credential | LMHC, LPC
-----------------------------------------------------
Telephone | 888-988-3008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------