Provider Demographics
NPI:1558122887
Name:WELLNESS & TRANSFORMATION LLC
Entity Type:Organization
Organization Name:WELLNESS & TRANSFORMATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLORIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-704-0909
Mailing Address - Street 1:3512 SPRINGWHEAT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5649
Mailing Address - Country:US
Mailing Address - Phone:224-704-0909
Mailing Address - Fax:
Practice Address - Street 1:4249 E STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2045
Practice Address - Country:US
Practice Address - Phone:224-704-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty