MEDICARE: ATARAXIA WELLNESS PROJECT NORTH LLC

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	:	1821965187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATARAXIA WELLNESS PROJECT NORTH LLC

Provider Business Mailing Address
First Line	:	25371 STORMS RD
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358-9665
Country	:	US
Telephone Number	:	937-210-9116
Fax Number	:

Provider Business Practice Location Address
First Line	:	25371 STORMS RD
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358-9665
Country	:	US
Telephone Number	:	937-210-9116
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS AMANDA FAYE PRICE
Credential	:	LISW-S, LCSW
Telephone Number	:	740-262-8710

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	12/10/2025

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