Provider Demographics
NPI:1265834766
Name:THE WHOLENESS CENTER, LLC
Entity Type:Organization
Organization Name:THE WHOLENESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-580-3800
Mailing Address - Street 1:1367 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7111
Mailing Address - Country:US
Mailing Address - Phone:508-580-3800
Mailing Address - Fax:508-580-3805
Practice Address - Street 1:370 OAK ST STE C
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1303
Practice Address - Country:US
Practice Address - Phone:508-580-3800
Practice Address - Fax:508-580-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MAS50130595251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty