Provider Demographics
NPI:1083166227
Name:WELL-LIFE COUNSELING & SPIRITUAL CENTER
Entity Type:Organization
Organization Name:WELL-LIFE COUNSELING & SPIRITUAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMECA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-557-3901
Mailing Address - Street 1:301 S CHURCH ST STE 254
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-5749
Mailing Address - Country:US
Mailing Address - Phone:252-557-3901
Mailing Address - Fax:
Practice Address - Street 1:301 S CHURCH ST STE 254
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5749
Practice Address - Country:US
Practice Address - Phone:252-557-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097201041C0700X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty