Provider Demographics
NPI:1164872883
Name:SAND DOLLAR WELLNESS CENTER, P.C.
Entity Type:Organization
Organization Name:SAND DOLLAR WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:WHITTED
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCAS-A
Authorized Official - Phone:910-233-8082
Mailing Address - Street 1:7705 MASONBORO SOUND RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2670
Mailing Address - Country:US
Mailing Address - Phone:910-233-8082
Mailing Address - Fax:
Practice Address - Street 1:1136 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6439
Practice Address - Country:US
Practice Address - Phone:910-233-8082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9089101Y00000X
NC3720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396087532OtherPERSONAL NPI