Provider Demographics
NPI:1780276824
Name:WYZDOM GROUP THERAPEUTIC COUNSELING SERVICES
Entity type:Organization
Organization Name:WYZDOM GROUP THERAPEUTIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELERICK
Authorized Official - Middle Name:WINFRED
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:678-462-5760
Mailing Address - Street 1:4315 MILLIS RD APT 107
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8975
Mailing Address - Country:US
Mailing Address - Phone:678-462-5760
Mailing Address - Fax:
Practice Address - Street 1:7910 MALL RING RD STE 200
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-2698
Practice Address - Country:US
Practice Address - Phone:678-462-5760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty