Provider Demographics
NPI:1770318867
Name:THE WELLNESS MISSION, LLC
Entity type:Organization
Organization Name:THE WELLNESS MISSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-638-5833
Mailing Address - Street 1:418 BROADWAY STE N
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2922
Mailing Address - Country:US
Mailing Address - Phone:347-638-5833
Mailing Address - Fax:
Practice Address - Street 1:418 BROADWAY STE N
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2922
Practice Address - Country:US
Practice Address - Phone:347-638-5833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty