MEDICARE: ASPIRE WELLNESS OF EAST COBB LLC

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	:	1932031630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE WELLNESS OF EAST COBB LLC

Provider Business Mailing Address
First Line	:	1640 POWERS FERRY RD SE BLD 21 SUITE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067
Country	:	US
Telephone Number	:	678-540-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 POWERS FERRY RD BUILDING 21 SUITE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067
Country	:	US
Telephone Number	:	678-540-4757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES DANIEL ALLEN III
Credential	:	PSY.D.
Telephone Number	:	404-824-3330

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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