Provider Demographics
NPI:1952870792
Name:PSYCHWELLNESS, LLC
Entity Type:Organization
Organization Name:PSYCHWELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:207-749-0018
Mailing Address - Street 1:85 STOCURRO DR
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3051
Mailing Address - Country:US
Mailing Address - Phone:207-749-0018
Mailing Address - Fax:
Practice Address - Street 1:169 PARK ROW STE 6
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2039
Practice Address - Country:US
Practice Address - Phone:207-547-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)