Healthcare Provider Details

I. General information

NPI: 1326779612
Provider Name (Legal Business Name): WELLNESS WITHIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 REGENCY RD STE 3
LEXINGTON KY
40503-2334
US

IV. Provider business mailing address

2523 MABLE LN
LEXINGTON KY
40511-8366
US

V. Phone/Fax

Practice location:
  • Phone: 317-659-0002
  • Fax:
Mailing address:
  • Phone: 859-396-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. SHERICKA DANIELLE SMITH
Title or Position: CO-OWNER
Credential: LCSW
Phone: 859-396-2031