Provider Demographics
NPI:1699383810
Name:MODERN WELLNESS SERVICES, LLC DBA MODERN DAY THERAPY
Entity Type:Organization
Organization Name:MODERN WELLNESS SERVICES, LLC DBA MODERN DAY THERAPY
Other - Org Name:MODERN DAY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-751-3545
Mailing Address - Street 1:1515 FOOTE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2816
Mailing Address - Country:US
Mailing Address - Phone:404-751-3545
Mailing Address - Fax:
Practice Address - Street 1:1515 FOOTE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2816
Practice Address - Country:US
Practice Address - Phone:404-751-3545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty