Provider Demographics
NPI:1841006186
Name:STARDUST NEUROAFFIRMING WELLNESS LLC
Entity type:Organization
Organization Name:STARDUST NEUROAFFIRMING WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGIACINTO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:832-738-9647
Mailing Address - Street 1:3408 WOODLAND AVE STE 305A
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6506
Mailing Address - Country:US
Mailing Address - Phone:832-738-9647
Mailing Address - Fax:
Practice Address - Street 1:3408 WOODLAND AVE STE 305A
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6506
Practice Address - Country:US
Practice Address - Phone:505-605-6455
Practice Address - Fax:505-485-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health