Provider Demographics
NPI:1508613126
Name:SYMBIOSIS MENTAL HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:SYMBIOSIS MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:IANNAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-492-4351
Mailing Address - Street 1:6650 RIVERS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4829
Mailing Address - Country:US
Mailing Address - Phone:843-284-3116
Mailing Address - Fax:
Practice Address - Street 1:515 ROBERT DANIEL DR APT 5302
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7347
Practice Address - Country:US
Practice Address - Phone:843-284-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty