I.M. Wellness Center, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

LPC009820 Issued in GA

Legal business name

I.M. WELLNESS CENTER, LLC

Practice address

120 MLK Sr Heritage TRL Ste 110
Stockbridge, GA 30281-3411

Phone

(770) 990-2453

Fax

(706) 553-8306

NPI assigned

Apr 25, 2018

Last updated

Dec 8, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Cindy Hardy, LPC, MAC, ICADC-IINPI 1235503418

Title

Ceo

Phone

(770) 990-2453

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cindy Hardy, EDD, MAC, LPC

  • Professional Counselor
  • Stockbridge, GA
  • NPI 1235503418
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544227200000",
    "number": "1659869626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 REDHEAD CT",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814473",
            "telephone_number": "770-990-2453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MLK SR HERITAGE TRL STE 110",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302813411",
            "telephone_number": "770-990-2453",
            "fax_number": "706-553-8306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1057 Redhead Ct",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302814473",
            "country_code": "US",
            "telephone_number": "770-990-2453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "I.M. WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-12-08",
        "status": "A",
        "authorized_official_last_name": "HARDY",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-990-2453",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LPC, MAC, ICADC-II"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "LPC009820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Adult Mental Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.