Healthcare Provider Details

I. General information

NPI: 1841382173
Provider Name (Legal Business Name): TRINITY WELLNESS CENTER OF WILMINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 S 17TH ST SUITE 1
WILMINGTON NC
28401-6626
US

IV. Provider business mailing address

1907 S 17TH ST SUITE 1
WILMINGTON NC
28401-6626
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8424
  • Fax: 910-343-6989
Mailing address:
  • Phone: 910-343-8424
  • Fax: 910-343-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9600112
License Number StateNC

VIII. Authorized Official

Name: MARISA MARTELL
Title or Position: CREDENTIALLING MANAGER
Credential:
Phone: 904-420-7343