Provider Demographics
NPI:1477320885
Name:DALLAS IVY THERAPY AND WELLNESS SERVICES
Entity Type:Organization
Organization Name:DALLAS IVY THERAPY AND WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CPCS
Authorized Official - Phone:404-934-8428
Mailing Address - Street 1:298 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6216
Mailing Address - Country:US
Mailing Address - Phone:404-934-8428
Mailing Address - Fax:
Practice Address - Street 1:298 NORTHWIND DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6216
Practice Address - Country:US
Practice Address - Phone:404-934-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty