=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588510085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARIS WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2026
-----------------------------------------------------
Last Update Date | 03/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2909 S DOBSON RD STE 14
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85202-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-531-4348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 S SUNSET DR
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85286-1872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-531-4348
-----------------------------------------------------
Fax | 480-531-4348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AYOOLA OGEDENGBE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 480-531-4348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------