Provider Demographics
NPI:1386001956
Name:WELLSPRING LIFE EDUCATIONAL & COUNSELING GROUP
Entity Type:Organization
Organization Name:WELLSPRING LIFE EDUCATIONAL & COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKEACHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-953-2590
Mailing Address - Street 1:PO BOX 30325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30332-1001
Mailing Address - Country:US
Mailing Address - Phone:678-752-1109
Mailing Address - Fax:
Practice Address - Street 1:155 HUMBOLDT DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2026
Practice Address - Country:US
Practice Address - Phone:678-752-1109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health