Provider Demographics
NPI:1215821996
Name:PLAY 21 WELLNESS ACADEMY LLC
Entity type:Organization
Organization Name:PLAY 21 WELLNESS ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-347-5887
Mailing Address - Street 1:3580 BRECKINRIDGE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5256
Mailing Address - Country:US
Mailing Address - Phone:770-680-5642
Mailing Address - Fax:
Practice Address - Street 1:3580 BRECKINRIDGE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5256
Practice Address - Country:US
Practice Address - Phone:770-680-5642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty