Provider Demographics
NPI:1295302305
Name:NEW CREATION WELLNESS CENTER INC
Entity type:Organization
Organization Name:NEW CREATION WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-731-1114
Mailing Address - Street 1:6853 DOUGLAS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7178
Mailing Address - Country:US
Mailing Address - Phone:770-731-1114
Mailing Address - Fax:404-682-1396
Practice Address - Street 1:6853 DOUGLAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7178
Practice Address - Country:US
Practice Address - Phone:770-731-1114
Practice Address - Fax:404-682-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty