Provider Demographics
NPI:1043051501
Name:HEALING SPACE OF ATHENS LLC
Entity type:Organization
Organization Name:HEALING SPACE OF ATHENS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-425-8900
Mailing Address - Street 1:1 HUNTINGTON RD STE 703
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7214
Mailing Address - Country:US
Mailing Address - Phone:706-425-8900
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTINGTON RD STE 703
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7214
Practice Address - Country:US
Practice Address - Phone:706-425-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty