Provider Demographics
NPI:1417692914
Name:CENTER FOR MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:CENTER FOR MENTAL WELLNESS LLC
Other - Org Name:CENTER FOR MENTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTEA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-598-8810
Mailing Address - Street 1:3018 OAKLAND DR STE D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3998
Mailing Address - Country:US
Mailing Address - Phone:269-598-8810
Mailing Address - Fax:
Practice Address - Street 1:3018 OAKLAND DR STE D
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3998
Practice Address - Country:US
Practice Address - Phone:269-598-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI112427979765OtherAMY WILSON, LMSW, CAAC
MI1558508929OtherFAITH COSTEA LMSW