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General NPI Number Information
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NPI Number | 1063371920
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Entity Type | Organization
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Legal Business Name | THE STUDENT WELLNESS CO. LLC
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 220 S MAIN ST
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City | ROYAL OAK
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State | MI
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Zip | 48067-2676
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Country | US
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Telephone | 248-671-6649
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Fax |
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Provider Business Mailing Address
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Address Line | 220 S MAIN ST
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City | ROYAL OAK
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State | MI
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Zip | 48067-2676
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Country | US
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Telephone | 248-671-6649
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | GABRIELLE JOY WARDLAW-PFAFF
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Credential | LPC
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Telephone | 248-850-0073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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