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General NPI Number Information
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NPI Number | 1821766007
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Entity Type | Organization
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Legal Business Name | NUTRITIONAL & PSYCHOLOGICAL WELLNESS, LLC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 107 E PARK AVE
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City | GREENVILLE
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State | SC
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Zip | 29601-1631
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Country | US
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Telephone | 864-735-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 69 SIKES CIR
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City | MAULDIN
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State | SC
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Zip | 29662-2590
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Country | US
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Telephone | 716-628-8250
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED PROFESSIONAL COUNSE
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Name | MS. AUDREY SUZANNE CONNELL
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Credential | MA, LPC
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Telephone | 864-735-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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