MEDICARE: MAXEMA & ESTELLE WELLNESS SOLUTIONS, 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1780256164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXEMA & ESTELLE WELLNESS SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1540 CENTER POINT PKWY STE 202
Second Line	:
City	:	CENTER POINT
State	:	AL
Zip	:	35215-5666
Country	:	US
Telephone Number	:	205-718-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 CENTER POINT PKWY STE 202
Second Line	:
City	:	CENTER POINT
State	:	AL
Zip	:	35215-5666
Country	:	US
Telephone Number	:	205-718-1503
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	KENDRALIA AGAZIE
Credential	:	RN, LGSW
Telephone Number	:	205-718-1503

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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