Provider Demographics
NPI:1497481972
Name:AGAPE HEALING AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:AGAPE HEALING AND WELLNESS CENTER PLLC
Other - Org Name:AGAPE HEALING AND WELLNESS CENTER PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DARNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-807-1692
Mailing Address - Street 1:13810 CHAMPION FOREST DR STE 150
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1883
Mailing Address - Country:US
Mailing Address - Phone:919-807-1692
Mailing Address - Fax:833-980-1022
Practice Address - Street 1:13810 CHAMPION FOREST DR STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1883
Practice Address - Country:US
Practice Address - Phone:919-807-1692
Practice Address - Fax:833-980-1022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGAPE HEALING AND WELLNESS CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1161069150003OtherINSURANCE