Provider Demographics
NPI:1932700606
Name:THE WELLHOUSE
Entity Type:Organization
Organization Name:THE WELLHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAVAROUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-299-3350
Mailing Address - Street 1:PO BOX 362183
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30036-2183
Mailing Address - Country:US
Mailing Address - Phone:404-783-9620
Mailing Address - Fax:
Practice Address - Street 1:1235 EASTRIDGE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3427
Practice Address - Country:US
Practice Address - Phone:770-299-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WELLHOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty