Provider Demographics
NPI:1770020018
Name:TOTAL WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:TOTAL WELLNESS CENTERS, LLC
Other - Org Name:CLEANSLATE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-798-8160
Mailing Address - Street 1:12 CADILLAC DR STE 380
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5362
Mailing Address - Country:US
Mailing Address - Phone:615-425-0220
Mailing Address - Fax:
Practice Address - Street 1:59 BOBALA RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-9689
Practice Address - Country:US
Practice Address - Phone:413-584-2173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory