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General NPI Number Information
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NPI Number | 1538029293
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Entity Type | Organization
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Legal Business Name | INNOVATIVE WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 2520 IMPATIEN DR
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City | CHARLOTTE
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State | NC
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Zip | 28215-7739
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Country | US
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Telephone | 917-841-7842
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 IMPATIEN DR
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City | CHARLOTTE
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State | NC
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Zip | 28215-7739
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Country | US
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Telephone | 917-841-7842
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Fax |
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Authorized Official
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Title or Position | LCASA COUNSELOR/TCM SUPERVISOR
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Name | DR. GEORGINA FIORENTINO
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Credential | EDD, LCASA
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Telephone | 917-841-7842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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