Provider Demographics
NPI:1609417468
Name:THE WELL MIND, PLLC
Entity Type:Organization
Organization Name:THE WELL MIND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILREATH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-505-9355
Mailing Address - Street 1:3653 BEESON DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9722
Mailing Address - Country:US
Mailing Address - Phone:336-505-9355
Mailing Address - Fax:
Practice Address - Street 1:213 W 6TH ST STE 6
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2901
Practice Address - Country:US
Practice Address - Phone:336-505-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty