Healthcare Provider Details

I. General information

NPI: 1518874841
Provider Name (Legal Business Name): GLORIFIED BODY WELLSPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 JESSIE LN
CLEMMONS NC
27012-9887
US

IV. Provider business mailing address

6331 JESSIE LN
CLEMMONS NC
27012-9887
US

V. Phone/Fax

Practice location:
  • Phone: 336-520-5485
  • Fax:
Mailing address:
  • Phone: 336-520-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GERMAINE BROWN
Title or Position: PROVIDER, HEALTH EDUCATOR
Credential:
Phone: 336-520-5485