Healthcare Provider Details

I. General information

NPI: 1942754064
Provider Name (Legal Business Name): TOTAL WELLNESS ADVOCATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 INEICHEN ST
RAYVILLE LA
71269-3223
US

IV. Provider business mailing address

114 INEICHEN ST
RAYVILLE LA
71269-3223
US

V. Phone/Fax

Practice location:
  • Phone: 708-710-9969
  • Fax:
Mailing address:
  • Phone: 708-710-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLC42325974K
License Number StateLA

VIII. Authorized Official

Name: SHANDRA N SMITH
Title or Position: OWNER
Credential:
Phone: 708-710-9969