Provider Demographics
NPI:1467083220
Name:WELLNESS ALLIANCE COUNSELING & PSYCHOTHERAPY
Entity Type:Organization
Organization Name:WELLNESS ALLIANCE COUNSELING & PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSICAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:314-391-8030
Mailing Address - Street 1:26 GODWIN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1542
Mailing Address - Country:US
Mailing Address - Phone:314-971-0900
Mailing Address - Fax:
Practice Address - Street 1:8008 CARONDELET AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1724
Practice Address - Country:US
Practice Address - Phone:314-391-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty