Provider Demographics
NPI:1114791969
Name:ENLIGHTENED WELLNESS SOLUTIONS LLC
Entity Type:Organization
Organization Name:ENLIGHTENED WELLNESS SOLUTIONS LLC
Other - Org Name:ENLIGHTENED WELLNESS SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF THE BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-224-4863
Mailing Address - Street 1:155 WILLOWBROOK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7033
Mailing Address - Country:US
Mailing Address - Phone:862-224-4863
Mailing Address - Fax:
Practice Address - Street 1:155 WILLOWBROOK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7033
Practice Address - Country:US
Practice Address - Phone:862-224-4863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty