Provider Demographics
NPI:1821540220
Name:JOURNEY WELLNESS & CONSULTING GROUP
Entity Type:Organization
Organization Name:JOURNEY WELLNESS & CONSULTING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF& CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-723-8859
Mailing Address - Street 1:364 E MAIN ST
Mailing Address - Street 2:STE 184
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1482
Mailing Address - Country:US
Mailing Address - Phone:302-723-8859
Mailing Address - Fax:302-351-7176
Practice Address - Street 1:364 E MAIN ST
Practice Address - Street 2:STE 184
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1482
Practice Address - Country:US
Practice Address - Phone:302-723-8859
Practice Address - Fax:302-351-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0014241041C0700X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250466630Medicaid