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General NPI Number Information
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NPI Number | 1306483979
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Entity Type | Organization
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Legal Business Name | NATURAL WELLNESS CLINICS, LLC
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 3000 FERN VALLEY RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-3522
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Country | US
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Telephone | 904-563-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 1468 PLAINFIELD AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-3923
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Country | US
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Telephone | 904-563-0332
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Fax |
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Authorized Official
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Title or Position | FOUNDING PARTNER/OWNER
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Name | TOMMIE DOUGLAS BENEFIELD JR.
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Credential | LHC
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Telephone | 904-563-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 101Y00000X
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Taxonomy Name | Counselor
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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