Provider Demographics
NPI:1912252313
Name:KEYS TO WOMEN'S WELLNESS LLC
Entity Type:Organization
Organization Name:KEYS TO WOMEN'S WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FANIKE
Authorized Official - Middle Name:KIARA
Authorized Official - Last Name:OLUGBALA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-502-5593
Mailing Address - Street 1:2283 NOTTLEY WALK
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8610
Mailing Address - Country:US
Mailing Address - Phone:770-502-5593
Mailing Address - Fax:866-310-1591
Practice Address - Street 1:2283 NOTTLEY WALK
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8610
Practice Address - Country:US
Practice Address - Phone:770-502-5593
Practice Address - Fax:866-310-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty