Healthcare Provider Details

I. General information

NPI: 1114460631
Provider Name (Legal Business Name): PALMS HEALTH AND WELLNESS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
SUPPLY NC
28462-3350
US

IV. Provider business mailing address

1362 SALEM DR
ALPHARETTA GA
30009-3148
US

V. Phone/Fax

Practice location:
  • Phone: 828-850-9789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number32978
License Number StateNC

VIII. Authorized Official

Name: KIMBERLY BLANKENSHIP
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 828-850-9789