Healthcare Provider Details

I. General information

NPI: 1922943307
Provider Name (Legal Business Name): THE WELL THERAPEUTIC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 LEBANON RD
DANVILLE KY
40422-9636
US

IV. Provider business mailing address

5245 LEBANON RD
DANVILLE KY
40422-9636
US

V. Phone/Fax

Practice location:
  • Phone: 859-516-1691
  • Fax:
Mailing address:
  • Phone: 859-516-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. STACIA RENEE HOLDERMAN
Title or Position: OWNER
Credential: LPCC-S
Phone: 859-516-1691