Healthcare Provider Details

I. General information

NPI: 1164872883
Provider Name (Legal Business Name): SAND DOLLAR WELLNESS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 SHIPYARD BLVD
WILMINGTON NC
28412-6439
US

IV. Provider business mailing address

7705 MASONBORO SOUND RD
WILMINGTON NC
28409-2670
US

V. Phone/Fax

Practice location:
  • Phone: 910-233-8082
  • Fax:
Mailing address:
  • Phone: 910-233-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9089
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3720
License Number StateNC

VIII. Authorized Official

Name: MISS ANNE EMERSON WHITTED
Title or Position: OWNER/THERAPIST
Credential: LPC, LCAS-A
Phone: 910-233-8082