Provider Demographics
NPI:1407231269
Name:NEW IMAGE WELLNESS
Entity Type:Organization
Organization Name:NEW IMAGE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ZANTHRESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:901-334-3145
Mailing Address - Street 1:3721 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5322
Mailing Address - Country:US
Mailing Address - Phone:901-334-4144
Mailing Address - Fax:901-334-3145
Practice Address - Street 1:3721 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5322
Practice Address - Country:US
Practice Address - Phone:901-334-4144
Practice Address - Fax:901-334-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty