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General NPI Number Information
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NPI Number | 1235952615
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Entity Type | Organization
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Legal Business Name | WHOLE CHILD MIND-BODY WELLNESS LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2046 N COUNTRY RD
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City | WADING RIVER
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State | NY
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Zip | 11792-1634
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Country | US
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Telephone | 631-838-7183
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Fax | 631-284-6109
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Provider Business Mailing Address
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Address Line | 228 PARK AVE S # 624554
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City | NEW YORK
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State | NY
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Zip | 10003-1502
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Country | US
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Telephone | 631-838-7183
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA HENDRICKSON
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Credential | PHD, LCSW
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Telephone | 631-838-7183
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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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