Healthcare Provider Details

I. General information

NPI: 1992466734
Provider Name (Legal Business Name): INTRINSIC HEALTH & WELLNESS SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 ELLIE AVE
FAYETTEVILLE NC
28314-8579
US

IV. Provider business mailing address

1722 ELLIE AVE
FAYETTEVILLE NC
28314-8579
US

V. Phone/Fax

Practice location:
  • Phone: 984-444-9533
  • Fax:
Mailing address:
  • Phone: 984-444-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: DR. LETITIA P JOHNSON-ARNOLD
Title or Position: CEO
Credential: MS, CHES, NBC-HWC
Phone: 984-444-9533