Provider Demographics
NPI:1922704824
Name:YOUR WELLNESS WAY, LLC
Entity Type:Organization
Organization Name:YOUR WELLNESS WAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LDN, CNS
Authorized Official - Phone:917-582-5421
Mailing Address - Street 1:68 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4708
Mailing Address - Country:US
Mailing Address - Phone:917-582-5421
Mailing Address - Fax:
Practice Address - Street 1:68 GREEN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4708
Practice Address - Country:US
Practice Address - Phone:917-582-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty