Provider Demographics
NPI:1215561139
Name:HEALING AND RENEWAL WELLNESS
Entity Type:Organization
Organization Name:HEALING AND RENEWAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-471-8090
Mailing Address - Street 1:138 TYE ST SE APT 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1155
Mailing Address - Country:US
Mailing Address - Phone:678-471-8090
Mailing Address - Fax:
Practice Address - Street 1:464 CHEROKEE AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3260
Practice Address - Country:US
Practice Address - Phone:678-379-7019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health