Provider Demographics
NPI:1790330140
Name:CHRISTIAN WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:CHRISTIAN WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:810-771-8948
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-0561
Mailing Address - Country:US
Mailing Address - Phone:810-771-8948
Mailing Address - Fax:
Practice Address - Street 1:2442 E MAPLE AVE STE 205
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4491
Practice Address - Country:US
Practice Address - Phone:810-771-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center