Provider Demographics
NPI:1568146397
Name:ATLANTA WELLNESS COLLECTIVE, LLC
Entity type:Organization
Organization Name:ATLANTA WELLNESS COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:THAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, CPCS
Authorized Official - Phone:678-587-8858
Mailing Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 210
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5826
Mailing Address - Country:US
Mailing Address - Phone:678-587-8858
Mailing Address - Fax:
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 210
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5826
Practice Address - Country:US
Practice Address - Phone:678-587-8858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty