Provider Demographics
NPI:1336887512
Name:GOODLIFE WELLNESS GROUP PLLC
Entity Type:Organization
Organization Name:GOODLIFE WELLNESS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROITORU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-275-2411
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-0672
Mailing Address - Country:US
Mailing Address - Phone:919-275-2411
Mailing Address - Fax:
Practice Address - Street 1:713 N ARENDELL AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2303
Practice Address - Country:US
Practice Address - Phone:919-275-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty