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General NPI Number Information
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NPI Number | 1750009676
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Entity Type | Organization
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Legal Business Name | WELLNESS CONSULTANTS
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 8225 ALLEN RD STE 1146
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City | ALLEN PARK
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State | MI
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Zip | 48101-1401
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Country | US
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Telephone | 734-931-6154
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 ALLEN RD STE 1146
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City | ALLEN PARK
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State | MI
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Zip | 48101-1401
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Country | US
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Telephone | 734-931-6154
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON MARCETIC
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Credential | NP
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Telephone | 734-931-6154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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