Provider Demographics
NPI:1326352733
Name:WELLS OF WHOLENESS, INC.
Entity Type:Organization
Organization Name:WELLS OF WHOLENESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:CHERIE'
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:THD, LPC, LMFT
Authorized Official - Phone:404-917-9355
Mailing Address - Street 1:PO BOX 956445
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9508
Mailing Address - Country:US
Mailing Address - Phone:770-564-9355
Mailing Address - Fax:770-564-9356
Practice Address - Street 1:2775 CRUSE RD STE 1201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7144
Practice Address - Country:US
Practice Address - Phone:770-564-9355
Practice Address - Fax:770-564-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005400101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X
GAMFT001139101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166388AMedicaid