Healthcare Provider Details

I. General information

NPI: 1821914730
Provider Name (Legal Business Name): BJC TOTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 S CHURCH ST STE 1
MOORESTOWN NJ
08057-2773
US

IV. Provider business mailing address

PO BOX 8755
BLACKWOOD NJ
08012-8755
US

V. Phone/Fax

Practice location:
  • Phone: 856-652-0222
  • Fax:
Mailing address:
  • Phone: 732-948-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRYANA CARREA
Title or Position: MANAGING MEMBER
Credential: APN
Phone: 732-948-6718