Provider Demographics
NPI:1629877402
Name:ANYCOLOR WELLNESS, LLC
Entity type:Organization
Organization Name:ANYCOLOR WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONAREV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-470-5199
Mailing Address - Street 1:20 RANDOLPH PL STE A
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4808
Mailing Address - Country:US
Mailing Address - Phone:347-668-0107
Mailing Address - Fax:
Practice Address - Street 1:20 RANDOLPH PL STE A
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4808
Practice Address - Country:US
Practice Address - Phone:347-668-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health