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General NPI Number Information
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NPI Number | 1922943307
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Entity Type | Organization
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Legal Business Name | THE WELL THERAPEUTIC GROUP, LLC
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 5245 LEBANON RD
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City | DANVILLE
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State | KY
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Zip | 40422-9636
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Country | US
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Telephone | 859-516-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 5245 LEBANON RD
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City | DANVILLE
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State | KY
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Zip | 40422-9636
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Country | US
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Telephone | 859-516-1691
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACIA RENEE HOLDERMAN
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Credential | LPCC-S
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Telephone | 859-516-1691
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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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