MEDICARE: I DESERVE MENTAL WELLNESS SERVICES

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
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1437830874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I DESERVE MENTAL WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	2301 PEACHTREE LANDING CIR
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-4270
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 PEACHTREE LANDING CIR
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-4270
Country	:	US
Telephone Number	:	404-482-0499
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	SHENEE JOHNSON
Credential	:
Telephone Number	:	404-482-0499

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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