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General NPI Number Information
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NPI Number | 1437896768
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Entity Type | Organization
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Legal Business Name | TLC WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 12 WORTHINGTON RD
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City | SCHENECTADY
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State | NY
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Zip | 12303-4826
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Country | US
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Telephone | 518-222-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WORTHINGTON RD
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City | SCHENECTADY
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State | NY
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Zip | 12303-4826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DARREN T DIAMOND
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Credential |
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Telephone | 518-222-6236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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