Provider Demographics
NPI:1235614678
Name:SPRINGS OF WELLNESS & CONSULTING, PLLC
Entity Type:Organization
Organization Name:SPRINGS OF WELLNESS & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLETA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WYLIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-999-3547
Mailing Address - Street 1:PO BOX 36213
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6213
Mailing Address - Country:US
Mailing Address - Phone:980-999-3547
Mailing Address - Fax:980-213-0283
Practice Address - Street 1:615 E 6TH ST STE 112
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2918
Practice Address - Country:US
Practice Address - Phone:980-999-3547
Practice Address - Fax:980-213-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770728909Medicaid