Provider Demographics
NPI:1215492251
Name:ORIGINS HEALTH AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ORIGINS HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OZIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:731-474-9121
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4053
Mailing Address - Country:US
Mailing Address - Phone:731-474-9121
Mailing Address - Fax:678-981-4601
Practice Address - Street 1:2727 PACES FERRY RD SE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4053
Practice Address - Country:US
Practice Address - Phone:731-474-9121
Practice Address - Fax:678-981-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty