MEDICARE: PRECIOUS HEALTH AND WELLNESS SPA INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TR0400X	Rehabilitation Psychologist
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740131176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIOUS HEALTH AND WELLNESS SPA INC

Provider Business Mailing Address
First Line	:	2945 DERITA AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3019
Country	:	US
Telephone Number	:	404-542-0704
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 DERITA AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3019
Country	:	US
Telephone Number	:	404-542-0704
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND OPERATOR
Name	:	MS. PRECIOUS STEPHENS KELLY
Credential	:
Telephone Number	:	404-542-0704

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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