Healthcare Provider Details

I. General information

NPI: 1780071183
Provider Name (Legal Business Name): TOTAL WELLNESS CONCEPTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 W SCHROCK RD SUITE A
WESTERVILLE OH
43081-2874
US

IV. Provider business mailing address

273 W SCHROCK RD SUITE A
WESTERVILLE OH
43081-2874
US

V. Phone/Fax

Practice location:
  • Phone: 614-414-0187
  • Fax:
Mailing address:
  • Phone: 614-414-0187
  • Fax:

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 Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: LAURA ATKINSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 614-414-0187