Provider Demographics
NPI:1356009146
Name:WHITE PINE WELLNESS, LLC
Entity Type:Organization
Organization Name:WHITE PINE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:PAYNE
Authorized Official - Last Name:CAPECCHI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-362-2378
Mailing Address - Street 1:1330 PARKWAY AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3006
Mailing Address - Country:US
Mailing Address - Phone:609-362-2378
Mailing Address - Fax:
Practice Address - Street 1:1330 PARKWAY AVE STE 7
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-362-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty