MEDICARE: SPELL THERAPY & WELLNESS PLLC

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	:	1316818743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPELL THERAPY & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	4030 WAKE FOREST RD STE 349
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-0010
Country	:	US
Telephone Number	:	919-400-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 TAWNY VIEW LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-9198
Country	:	US
Telephone Number	:	786-318-6674
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE SPELL
Credential	:
Telephone Number	:	786-318-6674

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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