Provider Demographics
NPI:1841925450
Name:SG WELLNESS MHC PLLC
Entity type:Organization
Organization Name:SG WELLNESS MHC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MHC
Authorized Official - Phone:347-475-1676
Mailing Address - Street 1:15 MACDONOUGH ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2303
Mailing Address - Country:US
Mailing Address - Phone:347-475-1676
Mailing Address - Fax:
Practice Address - Street 1:15 MACDONOUGH ST STE 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2303
Practice Address - Country:US
Practice Address - Phone:347-475-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578990958OtherCIGNA