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General NPI Number Information
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NPI Number | 1407676216
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Entity Type | Organization
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Legal Business Name | AEM WELLNESS LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 125 WAPPOO CREEK DR STE D4
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City | CHARLESTON
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State | SC
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Zip | 29412-2156
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Country | US
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Telephone | 864-934-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 493 WOODLAND SHORES RD
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City | CHARLESTON
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State | SC
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Zip | 29412-2426
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Country | US
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Telephone | 864-934-9764
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY ELIZABETH MOORE
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Credential | LPC
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Telephone | 864-934-9764
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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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