Provider Demographics
NPI:1164112801
Name:WELLNESS 4 LIFE LLC
Entity Type:Organization
Organization Name:WELLNESS 4 LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HWC
Authorized Official - Phone:205-740-5858
Mailing Address - Street 1:7841 1ST AVE N # 325
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-4354
Mailing Address - Country:US
Mailing Address - Phone:205-740-5858
Mailing Address - Fax:
Practice Address - Street 1:7841 1ST AVE N # 325
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-4354
Practice Address - Country:US
Practice Address - Phone:205-740-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty