Provider Demographics
NPI:1609680057
Name:WISE WOMAN EMBODIED LLC
Entity type:Organization
Organization Name:WISE WOMAN EMBODIED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TZIPPORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSON-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-913-1496
Mailing Address - Street 1:4001 RIVERLOOK PKWY SE UNIT 207
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4523
Mailing Address - Country:US
Mailing Address - Phone:706-424-2729
Mailing Address - Fax:
Practice Address - Street 1:1820 THE EXCHANGE SE STE 550
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2088
Practice Address - Country:US
Practice Address - Phone:404-913-1496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)