Provider Demographics
NPI:1679341127
Name:UPWELLING THERAPEUTIC SERVICES PLLC
Entity Type:Organization
Organization Name:UPWELLING THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LCMHCA
Authorized Official - Phone:704-315-4333
Mailing Address - Street 1:315 ANNABERG LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8652
Mailing Address - Country:US
Mailing Address - Phone:704-315-4333
Mailing Address - Fax:704-315-4333
Practice Address - Street 1:1932 WEDDINGTON RD
Practice Address - Street 2:
Practice Address - City:WEDDINGTON
Practice Address - State:NC
Practice Address - Zip Code:28104-8318
Practice Address - Country:US
Practice Address - Phone:704-931-5612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health