Provider Demographics
NPI:1124310693
Name:WHOLISTIC STRESS CONTROL INSTITUTE
Entity type:Organization
Organization Name:WHOLISTIC STRESS CONTROL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LPC
Authorized Official - Phone:404-755-0068
Mailing Address - Street 1:2545 BENJAMIN E MAYS DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2450
Mailing Address - Country:US
Mailing Address - Phone:404-707-0068
Mailing Address - Fax:404-755-4333
Practice Address - Street 1:2545 BENJAMIN E MAYS DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-2450
Practice Address - Country:US
Practice Address - Phone:404-707-0068
Practice Address - Fax:404-755-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X, 172V00000X, 174H00000X, 302R00000X
GALPC000390101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty