Provider Demographics
NPI:1184398430
Name:WELLNESS THERAPY CENTER LLC
Entity type:Organization
Organization Name:WELLNESS THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAIN PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NAGHAM
Authorized Official - Middle Name:RAZAQ
Authorized Official - Last Name:ALKHAFAJI
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:313-658-0388
Mailing Address - Street 1:685 N BECK RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4808
Mailing Address - Country:US
Mailing Address - Phone:313-658-0388
Mailing Address - Fax:
Practice Address - Street 1:685 N BECK RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4808
Practice Address - Country:US
Practice Address - Phone:313-658-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty