Provider Demographics
NPI:1649630328
Name:STC WELLNESS CENTER, INC
Entity type:Organization
Organization Name:STC WELLNESS CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-387-1611
Mailing Address - Street 1:150 CORA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4201
Mailing Address - Country:US
Mailing Address - Phone:225-387-1611
Mailing Address - Fax:225-343-5300
Practice Address - Street 1:150 CORA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4201
Practice Address - Country:US
Practice Address - Phone:225-387-1611
Practice Address - Fax:225-343-5300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STC ADDICTION WELLNESS CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)