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General NPI Number Information
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NPI Number | 1932031630
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Entity Type | Organization
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Legal Business Name | ASPIRE WELLNESS OF EAST COBB LLC
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Dates
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Enumeration Date | 05/29/2026
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Last Update Date | 05/29/2026
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD BUILDING 21 SUITE 200
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-540-4757
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 POWERS FERRY RD SE BLD 21 SUITE 200
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-540-4757
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES DANIEL ALLEN III
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Credential | PSY.D.
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Telephone | 404-824-3330
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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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