Provider Demographics
NPI:1245083179
Name:ONETHREE WELLNESS COLLECTIVE LLC
Entity type:Organization
Organization Name:ONETHREE WELLNESS COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-835-5103
Mailing Address - Street 1:3176 WARRENTON CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1395
Mailing Address - Country:US
Mailing Address - Phone:770-835-5103
Mailing Address - Fax:
Practice Address - Street 1:235 E PONCE DE LEON AVE STE 120
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3412
Practice Address - Country:US
Practice Address - Phone:770-835-5103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty