MEDICARE: GENERATIONAL HEALING AND WELLNESS THERAPY AND CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144119041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL HEALING AND WELLNESS THERAPY AND CONSULTING

Provider Business Mailing Address
First Line	:	636 FROW DR
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-7153
Country	:	US
Telephone Number	:	843-697-4465
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 FROW DR
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-7153
Country	:	US
Telephone Number	:	843-697-4465
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JERICHA PETERSON
Credential	:	LISW-CP, LCSW
Telephone Number	:	843-697-4465

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	05/28/2026

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Directions to “GENERATIONAL HEALING AND WELLNESS THERAPY AND CONSULTING ” Practice Location

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