Provider Demographics
NPI:1982071858
Name:WELLSPRING LIVING
Entity Type:Organization
Organization Name:WELLSPRING LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GED COACH
Authorized Official - Prefix:MS
Authorized Official - First Name:TIRZAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-410-2585
Mailing Address - Street 1:860 JOHNSON FERRY RD STE 140-330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1435
Mailing Address - Country:US
Mailing Address - Phone:239-410-2585
Mailing Address - Fax:
Practice Address - Street 1:3965 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-2607
Practice Address - Country:US
Practice Address - Phone:770-631-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACCI001962251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health