Provider Demographics
NPI:1467990234
Name:ESSENTIAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:ESSENTIAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-926-3010
Mailing Address - Street 1:3750 NW CARY PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8432
Mailing Address - Country:US
Mailing Address - Phone:919-926-3010
Mailing Address - Fax:
Practice Address - Street 1:3750 NW CARY PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8432
Practice Address - Country:US
Practice Address - Phone:919-926-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39104261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care