Healthcare Provider Details

I. General information

NPI: 1962033431
Provider Name (Legal Business Name): ACHIEVING WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SOUTH BOND STREET SUITE B
ROWLAND NC
28383
US

IV. Provider business mailing address

102 SOUTH BOND STREET SUITE B
ROWLAND NC
28383
US

V. Phone/Fax

Practice location:
  • Phone: 910-721-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY WILKINS
Title or Position: OWNER
Credential: FNP-C, PMHNP-BC
Phone: 910-720-1101