Provider Demographics
NPI:1437516531
Name:CREO WELLNESS, INC.
Entity Type:Organization
Organization Name:CREO WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-527-0518
Mailing Address - Street 1:2924 EMERYWOOD PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3746
Mailing Address - Country:US
Mailing Address - Phone:804-527-0815
Mailing Address - Fax:804-527-0915
Practice Address - Street 1:3460 MAYLAND CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1449
Practice Address - Country:US
Practice Address - Phone:804-527-0815
Practice Address - Fax:804-527-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232522261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health