Provider Demographics
NPI:1437875531
Name:CULTIVATED WELLSPRING, PLLC
Entity Type:Organization
Organization Name:CULTIVATED WELLSPRING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:336-265-7297
Mailing Address - Street 1:2910 BRIARCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3176
Mailing Address - Country:US
Mailing Address - Phone:336-265-7297
Mailing Address - Fax:336-773-0332
Practice Address - Street 1:2910 BRIARCLIFFE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3176
Practice Address - Country:US
Practice Address - Phone:336-265-7297
Practice Address - Fax:336-773-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health