Provider Demographics
NPI:1679237895
Name:ESSENTIAL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ESSENTIAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,MANAGER,CLINICALSOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-945-8123
Mailing Address - Street 1:44632 N BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1005
Mailing Address - Country:US
Mailing Address - Phone:586-945-8123
Mailing Address - Fax:
Practice Address - Street 1:44632 N BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1005
Practice Address - Country:US
Practice Address - Phone:586-945-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty