Provider Demographics
NPI:1457031627
Name:MENTAL WELLNESS IN MOTION LLC
Entity type:Organization
Organization Name:MENTAL WELLNESS IN MOTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:470-314-2490
Mailing Address - Street 1:1720 PEACHTREE ST NW STE 1010
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2497
Mailing Address - Country:US
Mailing Address - Phone:678-257-2655
Mailing Address - Fax:770-575-8712
Practice Address - Street 1:1720 PEACHTREE ST NW STE 1010
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2497
Practice Address - Country:US
Practice Address - Phone:678-257-2655
Practice Address - Fax:770-575-8712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty