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General NPI Number Information
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NPI Number | 1932700606
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Entity Type | Organization
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Legal Business Name | THE WELLHOUSE
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 11/07/2020
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Provider Practice Location Address
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Address Line | 1235 EASTRIDGE RD SW
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City | ATLANTA
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State | GA
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Zip | 30311-3427
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Country | US
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Telephone | 770-299-3350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 362183
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City | DECATUR
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State | GA
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Zip | 30036-2183
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Country | US
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Telephone | 404-783-9620
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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. TAVAROUS SAINT-LOUIS
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Credential | LPC
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Telephone | 770-299-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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