Provider Demographics
NPI:1760860936
Name:MENTAL WELLNESS GROUP PLLC
Entity Type:Organization
Organization Name:MENTAL WELLNESS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-427-7944
Mailing Address - Street 1:PO BOX 20867
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0526
Mailing Address - Country:US
Mailing Address - Phone:540-427-7944
Mailing Address - Fax:540-427-7945
Practice Address - Street 1:3959 ELECTRIC RD STE 280
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4572
Practice Address - Country:US
Practice Address - Phone:540-427-7944
Practice Address - Fax:540-427-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty