Provider Demographics
NPI:1609499706
Name:VIBE HEALING CENTER, LLC
Entity Type:Organization
Organization Name:VIBE HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLE
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:LEATH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC
Authorized Official - Phone:706-402-5445
Mailing Address - Street 1:240 NEW FRANKLIN RD # 1028
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2344
Mailing Address - Country:US
Mailing Address - Phone:706-350-4014
Mailing Address - Fax:706-786-0870
Practice Address - Street 1:210 YOUNGS MILL RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-5700
Practice Address - Country:US
Practice Address - Phone:706-350-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty