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General NPI Number Information
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NPI Number | 1154929123
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Entity Type | Organization
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Legal Business Name | CULTURE OF WELLNESS, LLC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 31 W 34TH ST # 7058
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City | NEW YORK
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State | NY
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Zip | 10001-3009
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Country | US
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Telephone | 646-757-4825
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Fax |
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Provider Business Mailing Address
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Address Line | 31 W 34TH ST # 7058
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City | NEW YORK
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State | NY
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Zip | 10001-3009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST, OWNER
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Name | LATOYA GAINES
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Credential | PSY.D.
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Telephone | 201-486-4518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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