Healthcare Provider Details

I. General information

NPI: 1053258459
Provider Name (Legal Business Name): DREAM WELLNESS NEXUS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5251 W CAMPBELL AVE STE 110
PHOENIX AZ
85031-1718
US

IV. Provider business mailing address

5251 W CAMPBELL AVE STE 110
PHOENIX AZ
85031-1718
US

V. Phone/Fax

Practice location:
  • Phone: 774-242-9221
  • Fax: 999-999-9999
Mailing address:
  • Phone: 774-242-9221
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: CELANDRIA EVETTAY BENNETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-415-6888