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General NPI Number Information
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NPI Number | 1871361352
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Entity Type | Organization
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Legal Business Name | REPLENISHING WELLNESS, LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 807 W HIGHWAY 50 STE 3
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City | O FALLON
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State | IL
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Zip | 62269-1856
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Country | US
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Telephone | 618-347-4129
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Fax | 618-247-4487
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Provider Business Mailing Address
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Address Line | 5850 MACKLIND AVE UNIT 100
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City | SAINT LOUIS
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State | MO
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Zip | 63109-3569
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Country | US
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Telephone | 618-347-4129
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Fax | 618-247-4487
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Authorized Official
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Title or Position | OWNER
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Name | ASHANTI MUHAMMAD-PITTMAN
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Credential | LCPC, CRC
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Telephone | 618-347-4129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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