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NPI Code Detail

MEDICARE: AUTHENTIC LIFE WELLNESS

MEDICARE: AUTHENTIC LIFE 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1972263218
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTHENTIC LIFE WELLNESS
Provider Business Mailing Address
First Line : 771 LINDBERGH DR NE APT 2102
Second Line :
City : ATLANTA
State : GA
Zip : 30324-3638
Country : US
Telephone Number : 678-296-4133
Fax Number :
Provider Business Practice Location Address
First Line : 67 PEACHTREE PARK DR NE STE 102
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1318
Country : US
Telephone Number : 470-298-6589
Fax Number : 404-921-9251
Authorized Official
Title or Position : OWNER/THERAPIST
Name : RACHELLE KENNEDY
Credential : LPC
Telephone Number : 678-296-4133
Provider Enumeration Date : 12/28/2021
Last Update Date : 12/28/2021

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Directions to “AUTHENTIC LIFE WELLNESS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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