Healthcare Provider Details

I. General information

NPI: 1902274020
Provider Name (Legal Business Name): TRANSFORMATIVE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2015
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S SOUTH ST
WILMINGTON OH
45177-2755
US

IV. Provider business mailing address

815 S SOUTH ST
WILMINGTON OH
45177-2755
US

V. Phone/Fax

Practice location:
  • Phone: 855-553-9355
  • Fax: 855-682-1823
Mailing address:
  • Phone: 855-553-9355
  • Fax: 855-682-1823

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA M HILL
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 855-553-9355