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General NPI Number Information
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NPI Number | 1992435663
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Entity Type | Organization
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Legal Business Name | THE WELLNESS COLLECTIVE LTD
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 10801 JOHNSTON RD
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City | CHARLOTTE
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State | NC
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Zip | 28226-4558
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Country | US
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Telephone | 704-837-2859
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Fax |
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Provider Business Mailing Address
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Address Line | 10801 JOHNSTON RD STE 119
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City | CHARLOTTE
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State | NC
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Zip | 28226-4490
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Country | US
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Telephone | 704-837-2859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES E WANKEL JR.
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Credential | LCSWA
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Telephone | 814-366-7037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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