Provider Demographics
NPI:1205695194
Name:JOURNEY TO INNER WELLNESS LLC
Entity type:Organization
Organization Name:JOURNEY TO INNER WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYSHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-240-0371
Mailing Address - Street 1:2242 TOWNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-6400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2242 TOWNSIDE DR
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:GA
Practice Address - Zip Code:30621-6400
Practice Address - Country:US
Practice Address - Phone:706-240-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health