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General NPI Number Information
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NPI Number | 1174120513
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Entity Type | Organization
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Legal Business Name | WELLS OF WELLNESS, LLC
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 993 SOUTH STREET APT, SUITE, FLOOR, ETC.
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City | ROSLINDALE
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State | MA
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Zip | 02131
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Country | US
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Telephone | 857-204-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CHARME AVE
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City | ROSLINDALE
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State | MA
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Zip | 02131-3113
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Country | US
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Telephone | 857-204-6773
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS JEANNETTA V MONTISSOL
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Credential | LMHC
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Telephone | 857-204-6773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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