Healthcare Provider Details

I. General information

NPI: 1255720967
Provider Name (Legal Business Name): WELLNESS WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 TURNHOUSE LN
SIMPSONVILLE SC
29681-4058
US

IV. Provider business mailing address

106 TURNHOUSE LN
SIMPSONVILLE SC
29681-4058
US

V. Phone/Fax

Practice location:
  • Phone: 864-609-7904
  • Fax: 864-757-9413
Mailing address:
  • Phone: 864-609-7904
  • Fax: 864-757-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number133
License Number StateSC

VIII. Authorized Official

Name: MRS. CYNTHIA LYNNE THOMAS
Title or Position: REGISTERED DIETITIAN
Credential: RD, LD, CDE
Phone: 864-455-4026