Healthcare Provider Details

I. General information

NPI: 1902022338
Provider Name (Legal Business Name): WELLNESS PROMOTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MORGANTOWN ST
UNIONTOWN PA
15401-4239
US

IV. Provider business mailing address

78 MORGANTOWN ST
UNIONTOWN PA
15401-4239
US

V. Phone/Fax

Practice location:
  • Phone: 724-439-4925
  • Fax:
Mailing address:
  • Phone: 724-439-4925
  • Fax: 724-437-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012896
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1255458980
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPRESIDENT INDIVIDUAL NPI

VIII. Authorized Official

Name: MS. JACQUELYN M. ALBERT
Title or Position: PRESIDENT
Credential: LCSW
Phone: 724-439-4925