MEDICARE: THE WELL MENTAL AND SPIRITUAL CARE, INC.

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1417733775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WELL MENTAL AND SPIRITUAL CARE, INC.

Provider Business Mailing Address
First Line	:	228 W EDENTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-1714
Country	:	US
Telephone Number	:	919-426-2315
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 W EDENTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-1714
Country	:	US
Telephone Number	:	210-262-6128
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. AMANDA RIGBY
Credential	:
Telephone Number	:	210-262-6128

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	02/09/2024

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