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General NPI Number Information
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NPI Number | 1609409762
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Entity Type | Organization
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Legal Business Name | DEFINING WELLNESS CENTERS , LLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 3949 HIGHWAY 43 N
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City | BRANDON
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State | MS
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Zip | 39047-7240
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Country | US
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Telephone | 769-241-2601
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Fax | 769-241-2605
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Provider Business Mailing Address
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Address Line | 3949 HIGHWAY 43 N
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City | BRANDON
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State | MS
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Zip | 39047-7240
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Country | US
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Telephone | 717-814-1970
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JENNY ZAYAS
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Credential |
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Telephone | 305-725-3748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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