Provider Demographics
NPI:1619648896
Name:MICHELLE AT THE HEALING CENTER ATLANTA
Entity Type:Organization
Organization Name:MICHELLE AT THE HEALING CENTER ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-955-5952
Mailing Address - Street 1:2690 COBB PKWY SE UNIT 246
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3001
Mailing Address - Country:US
Mailing Address - Phone:708-955-5952
Mailing Address - Fax:
Practice Address - Street 1:1830 WATER PL SE STE 295
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2293
Practice Address - Country:US
Practice Address - Phone:708-955-5952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty