Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Community Health/Public Health |
364SC1501X | 89 | Certified Clinical Nurse Specialist | |
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center |
| NPI # | 1952121386 |
| LBN Legal business name | WELLNESS DREAM CLINIC |
| Authorized official | GERTRUDE JANUARY - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/11/2024 |
| Last updated | 10/11/2024 - More than a year ago |
| Identifiers | n/a |
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