Provider Demographics
NPI:1891438313
Name:WELLNESS WITH AMI LLC
Entity Type:Organization
Organization Name:WELLNESS WITH AMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE-BENNING
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:937-203-0975
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-0549
Mailing Address - Country:US
Mailing Address - Phone:937-203-0975
Mailing Address - Fax:855-595-2759
Practice Address - Street 1:3331 STANLEY AVE STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-2022
Practice Address - Country:US
Practice Address - Phone:937-203-0975
Practice Address - Fax:855-595-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0483745Medicaid