Provider Demographics
NPI:1578156741
Name:GAIA WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:GAIA WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RIVES
Authorized Official - Middle Name:WHITTLE
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:304-319-0581
Mailing Address - Street 1:4945 MISSION ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9528
Mailing Address - Country:US
Mailing Address - Phone:304-319-0581
Mailing Address - Fax:888-972-8992
Practice Address - Street 1:4945 MISSION ROAD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9528
Practice Address - Country:US
Practice Address - Phone:304-319-0581
Practice Address - Fax:888-972-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health