One Wellness Boutique, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ONE WELLNESS BOUTIQUE, INC.

Practice address

931 Monroe Dr NE Ste A102-450
Atlanta, GA 30308-1793

Phone

(404) 789-4079

Fax

(877) 833-3855

NPI assigned

Apr 3, 2019

Organization subpart

Yes

Parent organization

ONE WELLNESS BOUTIQUE, INC.As reported in NPPES

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

Authorized official

Name

Mrs. Que'Ana Lache Morris JacksonNPI 1972856805

Title

Owner

Phone

(404) 789-4079

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• ONE Wellness Doing business as

Part of

One Wellness Boutique Inc

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Que'Ana Lache Morris Jackson

  • Community Health Worker
  • Atlanta, GA
  • NPI 1972856805
  NPD Authorized official

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1669934030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 MONROE DR NE STE A102-450",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303081793",
            "telephone_number": "404-789-4079",
            "fax_number": "877-833-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 MONROE DR NE STE A102-450",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303081793",
            "telephone_number": "404-789-4079",
            "fax_number": "877-833-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE WELLNESS BOUTIQUE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ONE WELLNESS BOUTIQUE, INC.",
        "enumeration_date": "2019-04-03",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "MORRIS JACKSON",
        "authorized_official_first_name": "QUE'ANA",
        "authorized_official_middle_name": "LACHE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-789-4079",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972856805",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ONE Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; 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.