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General NPI Number Information
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NPI Number | 1376241745
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Entity Type | Organization
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Legal Business Name | 360 WELLNESS CENTER LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 3008 SUDBURY DR
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City | DAYTON
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State | OH
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Zip | 45420-1129
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Country | US
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Telephone | 937-310-1269
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Fax | 855-631-4272
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Provider Business Mailing Address
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Address Line | 3008 SUDBURY DR
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City | DAYTON
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State | OH
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Zip | 45420-1129
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Country | US
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Telephone | 937-310-1269
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Fax | 855-631-4272
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY BROWN
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Credential | LICDC
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Telephone | 937-668-6633
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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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