Provider Demographics
NPI:1962845958
Name:WELLNESS INNOVATIONS HEALTHCARE SOLUTIONS
Entity Type:Organization
Organization Name:WELLNESS INNOVATIONS HEALTHCARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCASA
Authorized Official - Phone:919-522-2508
Mailing Address - Street 1:3650 ROGERS RD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9306
Mailing Address - Country:US
Mailing Address - Phone:919-522-2508
Mailing Address - Fax:
Practice Address - Street 1:3650 ROGERS RD
Practice Address - Street 2:SUITE 177
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9306
Practice Address - Country:US
Practice Address - Phone:919-522-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty