Healthcare Provider Details

I. General information

NPI: 1235083882
Provider Name (Legal Business Name): HOLY TRINITY WELLNESS & LEADERSHIP GROUP LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MAIN ST APT 7B
MILLBURN NJ
07041-1153
US

IV. Provider business mailing address

195 MAIN ST APT 7B
MILLBURN NJ
07041-1153
US

V. Phone/Fax

Practice location:
  • Phone: 862-246-0984
  • Fax:
Mailing address:
  • Phone: 862-246-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PROF. KELECHI OGBONNAYA EZEADI
Title or Position: OWNER/PRACTICE ADMINISTRATOR
Credential: EZEADI
Phone: 862-246-0984