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NPI Code Detail

MEDICARE: GOODLIFE WELLNESS GROUP PLLC

MEDICARE: GOODLIFE WELLNESS GROUP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1336887512
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOODLIFE WELLNESS GROUP PLLC
Provider Business Mailing Address
First Line : PO BOX 672
Second Line :
City : ZEBULON
State : NC
Zip : 27597-0672
Country : US
Telephone Number : 919-275-2411
Fax Number :
Provider Business Practice Location Address
First Line : 713 N ARENDELL AVE
Second Line :
City : ZEBULON
State : NC
Zip : 27597-2303
Country : US
Telephone Number : 919-275-2411
Fax Number :
Authorized Official
Title or Position : OWNER/PROVIDER
Name : MICHAEL CROITORU
Credential : LCSW
Telephone Number : 919-275-2411
Provider Enumeration Date : 05/26/2022
Last Update Date : 01/30/2024

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Directions to “GOODLIFE WELLNESS GROUP PLLC ” Practice Location

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