Provider Demographics
NPI:1922391341
Name:WELLBALANCE
Entity Type:Organization
Organization Name:WELLBALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-792-4121
Mailing Address - Street 1:609 WOODVINE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:617-792-4121
Mailing Address - Fax:
Practice Address - Street 1:49 SEAHORSE LN
Practice Address - Street 2:
Practice Address - City:CHRISTCHURCH
Practice Address - State:VA
Practice Address - Zip Code:23031-0001
Practice Address - Country:US
Practice Address - Phone:617-792-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health