Provider Demographics
NPI:1235371709
Name:MODERN WELLNESS PLLC
Entity Type:Organization
Organization Name:MODERN WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:BALDWIN ROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:910-642-8700
Mailing Address - Street 1:109 E WYCHE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3429
Mailing Address - Country:US
Mailing Address - Phone:910-642-8700
Mailing Address - Fax:910-642-0587
Practice Address - Street 1:109 E WYCHE ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3429
Practice Address - Country:US
Practice Address - Phone:910-642-8700
Practice Address - Fax:910-642-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health