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General NPI Number Information
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NPI Number | 1932753258
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Entity Type | Organization
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Legal Business Name | DIMENSIONS OF WELLNESS AND TRANSFORMATION, INC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 4249 E STATE ST STE 201
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City | ROCKFORD
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State | IL
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Zip | 61108-2045
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Country | US
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Telephone | 224-704-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 3512 SPRINGWHEAT
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City | ROCKFORD
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State | IL
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Zip | 61114-5649
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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 | CRISTINA GLORIA
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Credential | LCPC
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Telephone | 224-704-0909
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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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