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General NPI Number Information
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NPI Number | 1194920199
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Entity Type | Organization
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Legal Business Name | WELLNESS TRAINING ASSOCIATES INC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 201 W MARION ST STE 319
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City | SHELBY
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State | NC
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Zip | 28150-5094
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Country | US
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Telephone | 704-300-0086
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Fax | 704-300-0086
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Provider Business Mailing Address
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Address Line | PO BOX 2402
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City | SHELBY
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State | NC
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Zip | 28151-2402
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Country | US
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Telephone | 704-300-0086
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Fax | 704-300-0086
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Authorized Official
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Title or Position | THERAPIST
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Name | LINDA RADEKER
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Credential | MA, LPC
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Telephone | 704-300-0086
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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 | 2260
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License Number State | NC
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