MEDICARE: CULTIGREAT WELLNESS SOLUTIONS, 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1598545881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULTIGREAT WELLNESS SOLUTIONS, PLLC

Provider Business Mailing Address
First Line	:	1840 EASTCHESTER DR STE 106
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1496
Country	:	US
Telephone Number	:	919-397-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 EASTCHESTER DR STE 106
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1496
Country	:	US
Telephone Number	:	919-397-9402
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ELIZABETH RACHEL WATERS
Credential	:	LCSW
Telephone Number	:	919-397-9402

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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