Provider Demographics
NPI:1740886530
Name:WHOLE WELLNESS SERVICES, LICENSED MENTAL HEALTH COUNSELOR P.C.
Entity type:Organization
Organization Name:WHOLE WELLNESS SERVICES, LICENSED MENTAL HEALTH COUNSELOR P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:585-730-9769
Mailing Address - Street 1:200 FAIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 FAIRPORT RD
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1906
Practice Address - Country:US
Practice Address - Phone:585-730-9769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty