Healthcare Provider Details

I. General information

NPI: 1235077181
Provider Name (Legal Business Name): WELLNESS KORNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W BROAD ST STE 320
STAMFORD CT
06902-3758
US

IV. Provider business mailing address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-8017
  • Fax:
Mailing address:
  • Phone: 800-395-8017
  • Fax: 980-276-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KATO
Title or Position: OWNER
Credential: MD, MS, LPC
Phone: 800-395-8017