Provider Demographics
NPI:1326590357
Name:THE WESLEY CENTER FOR BEHAVIORAL WELLNESS
Entity Type:Organization
Organization Name:THE WESLEY CENTER FOR BEHAVIORAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLFREY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-653-0448
Mailing Address - Street 1:127 ENTERPRISE PATH STE 402
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2698
Mailing Address - Country:US
Mailing Address - Phone:678-653-0448
Mailing Address - Fax:800-717-0840
Practice Address - Street 1:127 ENTERPRISE PATH STE 402
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2698
Practice Address - Country:US
Practice Address - Phone:678-653-0448
Practice Address - Fax:800-717-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
GA14349581041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty