Healthcare Provider Details

I. General information

NPI: 1386262053
Provider Name (Legal Business Name): 1A WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MAIN ST STE 4
WENHAM MA
01984-1459
US

IV. Provider business mailing address

225 MAIN ST STE 4
WENHAM MA
01984-1459
US

V. Phone/Fax

Practice location:
  • Phone: 617-817-5237
  • Fax:
Mailing address:
  • Phone: 617-817-5237
  • 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 State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KRISTINA S. HARTER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 617-817-5237