Provider Demographics
NPI:1063014637
Name:UPLIFT WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:UPLIFT WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP, LCSW
Authorized Official - Phone:864-313-7047
Mailing Address - Street 1:PO BOX 5524
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-5524
Mailing Address - Country:US
Mailing Address - Phone:864-313-7047
Mailing Address - Fax:864-670-8029
Practice Address - Street 1:3815 LAMAR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5739
Practice Address - Country:US
Practice Address - Phone:864-313-7047
Practice Address - Fax:864-670-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty