Provider Demographics
NPI:1558904938
Name:WELLNESS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:WELLNESS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:QUIZZINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-629-2424
Mailing Address - Street 1:8503 GREENS LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1124
Mailing Address - Country:US
Mailing Address - Phone:443-629-2424
Mailing Address - Fax:
Practice Address - Street 1:8503 GREENS LN
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1124
Practice Address - Country:US
Practice Address - Phone:443-629-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty