MEDICARE: HOLISTIC COUNSELING AND WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1437743960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC COUNSELING AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2532 N DECATUR RD APT 1515
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6181
Country	:	US
Telephone Number	:	404-974-6578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2274 SALEM RD SE # 106-1048
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-2097
Country	:	US
Telephone Number	:	404-974-6578
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MELISSA MORGAN
Credential	:	LPC
Telephone Number	:	404-974-6578

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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