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General NPI Number Information
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NPI Number | 1750206652
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Entity Type | Organization
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Legal Business Name | OUR HEALING SPACE, LLC
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 165 TWIN HILL RD
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City | AUSTELL
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State | GA
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Zip | 30168-7724
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Country | US
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Telephone | 678-399-2070
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Fax | 404-537-6836
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Provider Business Mailing Address
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Address Line | 1445 WOODMONT LN NW # 1576
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 678-399-2070
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Fax | 404-537-6836
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARIUS HAYNES
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Credential | LPC
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Telephone | 678-439-9804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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