Healthcare Provider Details

I. General information

NPI: 1801549282
Provider Name (Legal Business Name): OHANA THERAPY AND WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 SIVERTSEN RD
AUTRYVILLE NC
28318-8520
US

IV. Provider business mailing address

1104B MASTERS LN
GREENVILLE NC
27834-8019
US

V. Phone/Fax

Practice location:
  • Phone: 910-835-8504
  • Fax:
Mailing address:
  • Phone: 910-835-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRANDI HUDSON
Title or Position: OWNER
Credential: LCSW
Phone: 910-835-8504