Healthcare Provider Details

I. General information

NPI: 1811599475
Provider Name (Legal Business Name): LOTUS WISDOM COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S CHERRY ST STE 400
WINSTON SALEM NC
27101-5271
US

IV. Provider business mailing address

138 S CHERRY ST STE 400
WINSTON SALEM NC
27101-5271
US

V. Phone/Fax

Practice location:
  • Phone: 336-892-9061
  • Fax: 336-899-0170
Mailing address:
  • Phone: 336-892-9061
  • Fax: 336-899-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY NICHOLE BODWELL
Title or Position: OWNER/THERAPIST
Credential: LCMHC
Phone: 336-892-9061