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Organization
PLAY WELLNESS LLC
Active
Organization
PLAY WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOLANDA FOUNTAIN PHD, LPC, RPT-S, ACS (OWNER)
(678) 871-9355
Entity
Organization
Contact information
Practice address
3545 BROAD ST # 80742, ATLANTA, GA 30341-2259
(770) 375-8124
Mailing address
3545 BROAD ST # 80742, ATLANTA, GA 30341-2259
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC006900
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003155496A
—
GA
Enumeration date
12/16/2014
Last updated
06/17/2016
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