Provider Demographics
NPI:1134947237
Name:HOUSE OF WELLNESS, LLC
Entity type:Organization
Organization Name:HOUSE OF WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENN-PEAY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-427-1979
Mailing Address - Street 1:9600 TWO NOTCH RD
Mailing Address - Street 2:SUITE 5 #1072
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1612
Mailing Address - Country:US
Mailing Address - Phone:803-427-1979
Mailing Address - Fax:
Practice Address - Street 1:9600 TWO NOTCH RD STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1612
Practice Address - Country:US
Practice Address - Phone:803-427-1979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty