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General NPI Number Information
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NPI Number | 1922554401
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Entity Type | Organization
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Legal Business Name | PREMIER WELLNESS HEALTHCARE
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 7 W MAIN ST
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City | FAWN GROVE
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State | PA
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Zip | 17321-9506
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Country | US
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Telephone | 888-333-1345
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Fax | 888-653-0154
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Provider Business Mailing Address
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Address Line | 133 BLACK OAK TRL
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City | DELTA
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State | PA
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Zip | 17314-8756
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Country | US
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Telephone | 888-653-3933
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Fax | 888-653-0154
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CYNTHIA DICARA
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Credential |
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Telephone | 410-459-7447
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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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