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General NPI Number Information
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NPI Number | 1609680057
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Entity Type | Organization
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Legal Business Name | WISE WOMAN EMBODIED LLC
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1820 THE EXCHANGE SE STE 550
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City | ATLANTA
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State | GA
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Zip | 30339-2088
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Country | US
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Telephone | 404-913-1496
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 RIVERLOOK PKWY SE UNIT 207
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City | MARIETTA
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State | GA
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Zip | 30067-4523
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Country | US
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Telephone | 706-424-2729
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | TZIPPORAH GERSON-MILLER
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Credential | LCSW
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Telephone | 404-913-1496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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