Provider Demographics
NPI:1518349000
Name:LAUNCH PAD WELLNESS LLC
Entity Type:Organization
Organization Name:LAUNCH PAD WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAS
Authorized Official - Phone:910-769-6053
Mailing Address - Street 1:3121 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4111
Mailing Address - Country:US
Mailing Address - Phone:910-769-6053
Mailing Address - Fax:
Practice Address - Street 1:3121 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4111
Practice Address - Country:US
Practice Address - Phone:910-769-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LAUNCH PAD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-22
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health