Provider Demographics
NPI:1942792346
Name:PARTNERS IN WELLNESS LLC
Entity Type:Organization
Organization Name:PARTNERS IN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:678-740-3578
Mailing Address - Street 1:1835 PITNER RD NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4486
Mailing Address - Country:US
Mailing Address - Phone:678-740-3578
Mailing Address - Fax:678-685-7196
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 622
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7777
Practice Address - Country:US
Practice Address - Phone:678-740-3578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty