Provider Demographics
NPI:1740900471
Name:WILDFLOWER WELLNESS LLC
Entity type:Organization
Organization Name:WILDFLOWER WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-218-9074
Mailing Address - Street 1:26 HOMESTEAD AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1928
Mailing Address - Country:US
Mailing Address - Phone:774-218-9074
Mailing Address - Fax:
Practice Address - Street 1:26 HOMESTEAD AVE APT 6
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1928
Practice Address - Country:US
Practice Address - Phone:774-218-9074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty