Provider Demographics
NPI:1942909403
Name:CULTIVATED WELLNESS PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:CULTIVATED WELLNESS PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-252-9303
Mailing Address - Street 1:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-0971
Mailing Address - Country:US
Mailing Address - Phone:207-252-9303
Mailing Address - Fax:
Practice Address - Street 1:8 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1612
Practice Address - Country:US
Practice Address - Phone:207-252-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty