Healthcare Provider Details

I. General information

NPI: 1174996847
Provider Name (Legal Business Name): ANCHORED IN WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E CHERRY ST
JESUP GA
31546-4872
US

IV. Provider business mailing address

311 E CHERRY ST
JESUP GA
31546-4872
US

V. Phone/Fax

Practice location:
  • Phone: 912-530-8889
  • Fax: 912-598-6109
Mailing address:
  • Phone: 912-530-8889
  • Fax: 912-598-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003662
License Number StateGA

VIII. Authorized Official

Name: SHAUNA MATTINGLY
Title or Position: OWNER
Credential: LCSW
Phone: 912-530-8889