MEDICARE: WELLNESS SUPPORTS, LLC

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	251S00000X	Community/Behavioral Health Agency	8300341B	NC
2	251S00000X	Community/Behavioral Health Agency	6005366	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1528138278	OTHER	NC	BLUE CROSS BLUE SHEILD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528138278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS SUPPORTS, LLC

Provider Business Mailing Address
First Line	:	8390 SIX FORKS RD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27615-3060
Country	:	US
Telephone Number	:	919-782-8730
Fax Number	:	919-782-8731

Provider Business Practice Location Address
First Line	:	8390 SIX FORKS RD
Second Line	:	SUITE 201
City	:	RALEIGH
State	:	NC
Zip	:	27615-3060
Country	:	US
Telephone Number	:	919-782-8730
Fax Number	:	919-782-8731

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. WENDY LYNN WENZEL
Credential	:	MSW
Telephone Number	:	919-782-8730

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	10/07/2009

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Directions to “WELLNESS SUPPORTS, LLC ” Practice Location

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