Provider Demographics
NPI:1336925247
Name:BE WELL RESOURCE GROUP
Entity Type:Organization
Organization Name:BE WELL RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKENDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-558-6333
Mailing Address - Street 1:7063 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4417
Mailing Address - Country:US
Mailing Address - Phone:252-558-6333
Mailing Address - Fax:
Practice Address - Street 1:7063 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4417
Practice Address - Country:US
Practice Address - Phone:252-558-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty