Provider Demographics
NPI:1649809666
Name:GUIDING WELLNESS INSTITUTE
Entity type:Organization
Organization Name:GUIDING WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELSY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-864-6257
Mailing Address - Street 1:143 SKATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2640
Mailing Address - Country:US
Mailing Address - Phone:910-864-6257
Mailing Address - Fax:
Practice Address - Street 1:143 SKATEWAY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2640
Practice Address - Country:US
Practice Address - Phone:910-864-6257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275172298Medicaid