Provider Demographics
NPI:1851923965
Name:NEW VISIONS WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:NEW VISIONS WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC/S, LAC, NCC
Authorized Official - Phone:803-479-4629
Mailing Address - Street 1:7 CATAWBA WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6033
Mailing Address - Country:US
Mailing Address - Phone:803-446-3905
Mailing Address - Fax:
Practice Address - Street 1:3545 W BELTLINE BLVD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7612
Practice Address - Country:US
Practice Address - Phone:803-479-4629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty