Provider Demographics
NPI:1437270923
Name:CRELVIS, INC.
Entity Type:Organization
Organization Name:CRELVIS, INC.
Other - Org Name:LAWRENCEVILLE THERAPY AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-378-6666
Mailing Address - Street 1:647 REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7475
Mailing Address - Country:US
Mailing Address - Phone:770-378-6666
Mailing Address - Fax:
Practice Address - Street 1:271-A S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4805
Practice Address - Country:US
Practice Address - Phone:770-676-6383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty