Provider Demographics
NPI:1952150187
Name:WELLNESS ACADEMY, LLC
Entity type:Organization
Organization Name:WELLNESS ACADEMY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:AS, BS
Authorized Official - Phone:949-335-2188
Mailing Address - Street 1:1501 INDIA ST STE 103-65
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2445
Mailing Address - Country:US
Mailing Address - Phone:310-497-7904
Mailing Address - Fax:
Practice Address - Street 1:1501 INDIA ST STE 103-65
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2445
Practice Address - Country:US
Practice Address - Phone:310-497-7904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty