Provider Demographics
NPI:1073041661
Name:PURPOSEFUL WELLNESS
Entity Type:Organization
Organization Name:PURPOSEFUL WELLNESS
Other - Org Name:DESIGNED BY PURPOSE COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-521-9172
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-0511
Mailing Address - Country:US
Mailing Address - Phone:803-470-4076
Mailing Address - Fax:803-470-4926
Practice Address - Street 1:523 BOULDER CT
Practice Address - Street 2:
Practice Address - City:GRANITEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29829-6018
Practice Address - Country:US
Practice Address - Phone:803-470-4076
Practice Address - Fax:803-470-4926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPOSEFUL WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-26
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8399Medicaid