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General NPI Number Information
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NPI Number | 1730709478
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Entity Type | Organization
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Legal Business Name | THE RIVER WELLNESS LLC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 245 KATHERINE DR STE D
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City | FLOWOOD
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State | MS
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Zip | 39232-9588
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Country | US
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Telephone | 888-402-0840
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 321383
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City | FLOWOOD
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State | MS
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Zip | 39232-1383
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Country | US
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Telephone | 888-402-0840
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA RUTH CRUZ
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Credential | LCSW
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Telephone | 803-260-6520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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