Healthcare Provider Details

I. General information

NPI: 1629542287
Provider Name (Legal Business Name): MADE WELL CENTER FOR WHOLENESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 GROUSE WOODS DR
WILMINGTON NC
28411-6538
US

IV. Provider business mailing address

4914 GROUSE WOODS DR
WILMINGTON NC
28411-6538
US

V. Phone/Fax

Practice location:
  • Phone: 252-902-6648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHELSIE ANDREWS
Title or Position: OWNER/THERAPIST
Credential:
Phone: 252-902-6648