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General NPI Number Information
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NPI Number | 1134947237
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Entity Type | Organization
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Legal Business Name | HOUSE OF WELLNESS, LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 9600 TWO NOTCH RD STE 5
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City | COLUMBIA
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State | SC
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Zip | 29223-1612
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Country | US
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Telephone | 803-427-1979
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 TWO NOTCH RD SUITE 5 #1072
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City | COLUMBIA
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State | SC
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Zip | 29223-1612
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Country | US
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Telephone | 803-427-1979
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DISHA BENN-PEAY
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Credential | LISW-CP
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Telephone | 803-427-1979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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