Organization
ONE WELLNESS BOUTIQUE, INC.
Active
Parent organization
ONE WELLNESS BOUTIQUE, INC.
Other names
ONE Wellness
Organization subpart
Yes
Provider details
NPI number
Legal business name
ONE WELLNESS BOUTIQUE, INC.
Authorized official
MRS. QUE'ANA LACHE MORRIS JACKSON (OWNER)
(404) 789-4079
Entity
Organization
Contact information
Practice address
931 MONROE DR NE STE A102-450, ATLANTA, GA 30308-1793
(404) 789-4079
(877) 833-3855
Mailing address
931 MONROE DR NE STE A102-450, ATLANTA, GA 30308-1793
(404) 789-4079
(877) 833-3855
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972856805
—
GA
Enumeration date
04/03/2019
Last updated
04/03/2019
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