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General NPI Number Information
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NPI Number | 1912830225
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Entity Type | Organization
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Legal Business Name | ECLECTIC WELLNESS LLC
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 104B W NORTH 1ST ST
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City | SENECA
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State | SC
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Zip | 29678-3248
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Country | US
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Telephone | 864-533-4825
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Fax |
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Provider Business Mailing Address
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Address Line | 234 LITTLE CROWE CREEK RD
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City | PICKENS
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State | SC
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Zip | 29671-9632
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA STAINTON
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Credential | LISW-CP, C-PD, C-DBT
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Telephone | 864-533-4825
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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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