Healthcare Provider Details

I. General information

NPI: 1255258497
Provider Name (Legal Business Name): LUMEN CENTER FOR WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 STEVENSON DR
WILMINGTON NC
28405-1532
US

IV. Provider business mailing address

1013 STEVENSON DR
WILMINGTON NC
28405-1532
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-2219
  • Fax:
Mailing address:
  • Phone: 910-742-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MISS CLARE NICOLE ROLQUIN
Title or Position: OWNER AND CLINICAL DIRECTOR
Credential: LCSW, LCAS
Phone: 910-742-2219