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General NPI Number Information
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NPI Number | 1578375903
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Entity Type | Organization
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Legal Business Name | HEADSPACE MENTAL WELLNESS CLUB LLC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 527 COTTONWOOD CV
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City | HAHIRA
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State | GA
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Zip | 31632-1591
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Country | US
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Telephone | 229-375-1673
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Fax |
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Provider Business Mailing Address
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Address Line | 527 COTTONWOOD CV
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City | HAHIRA
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State | GA
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Zip | 31632-1591
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Country | US
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Telephone | 229-375-1673
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUNARI CODY
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Credential | LCSW
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Telephone | 229-375-1673
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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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