Provider Demographics
NPI:1326713231
Name:URBAN WELLNESS, LLC
Entity Type:Organization
Organization Name:URBAN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-285-7321
Mailing Address - Street 1:3070 N MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2756
Mailing Address - Country:US
Mailing Address - Phone:770-285-7321
Mailing Address - Fax:770-285-7619
Practice Address - Street 1:3070 N MAIN ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2756
Practice Address - Country:US
Practice Address - Phone:770-285-7321
Practice Address - Fax:770-285-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)