Organization
ASILI WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WARE SPENCER (OWNER)
(678) 404-1077
Entity
Organization
Contact information
Practice address
4325 1ST AVE # 1461, TUCKER, GA 30084-4498
(678) 404-1077
Mailing address
PO BOX 1461, TUCKER, GA 30085-1461
(678) 404-1077
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
12/20/2021
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