Provider Demographics
NPI:1174276513
Name:BALANCED WELLNESS, LLC
Entity Type:Organization
Organization Name:BALANCED WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PSYCHOLOGIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DUNIELLE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:910-378-9211
Mailing Address - Street 1:20 AHOY DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4307
Mailing Address - Country:US
Mailing Address - Phone:910-378-9211
Mailing Address - Fax:910-378-4565
Practice Address - Street 1:337 BUCKWALTER PLACE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5175
Practice Address - Country:US
Practice Address - Phone:910-378-9211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty