Healthcare Provider Details

I. General information

NPI: 1629864061
Provider Name (Legal Business Name): PREMIER WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N PROVIDENCE RD REAR ENTRANCE
MEDIA PA
19063-2518
US

IV. Provider business mailing address

511 N PROVIDENCE RD REAR ENTRANCE
MEDIA PA
19063-2518
US

V. Phone/Fax

Practice location:
  • Phone: 484-363-9280
  • Fax: 484-205-4950
Mailing address:
  • Phone: 484-363-9280
  • Fax: 484-205-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AMANDA KONIEWICZ
Title or Position: OWNER
Credential: PSY.D, LPC
Phone: 484-363-9280