MEDICARE: VIDA COUNSELING AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053248211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA COUNSELING AND WELLNESS

Provider Business Mailing Address
First Line	:	801 CHATTANOOGA AVE APT A300
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-8887
Country	:	US
Telephone Number	:	706-280-3214
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 N SELVIDGE ST STE 302
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-3101
Country	:	US
Telephone Number	:	706-280-3214
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERPAIST
Name	:	KEISHA MARIE HERNANDEZ
Credential	:	LPC
Telephone Number	:	706-280-3214

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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