Provider Demographics
NPI:1780256164
Name:MAXEMA & ESTELLE WELLNESS SOLUTIONS, LLC
Entity type:Organization
Organization Name:MAXEMA & ESTELLE WELLNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAZIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LGSW
Authorized Official - Phone:205-718-1503
Mailing Address - Street 1:1540 CENTER POINT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5666
Mailing Address - Country:US
Mailing Address - Phone:205-718-1503
Mailing Address - Fax:
Practice Address - Street 1:1540 CENTER POINT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-5666
Practice Address - Country:US
Practice Address - Phone:205-718-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty