1780276824 NPI number — WYZDOM GROUP THERAPEUTIC COUNSELING SERVICES

Table of content: ANITALEI D. ALEXIO APRN (NPI 1639154750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780276824 NPI number — WYZDOM GROUP THERAPEUTIC COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYZDOM GROUP THERAPEUTIC COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780276824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4315 MILLIS RD APT 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27282-8975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-462-5760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7910 MALL RING RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONECREST
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30038-2698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-462-5760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
MELERICK
Authorized Official Middle Name:
WINFRED
Authorized Official Title or Position:
CEO/ OWNER
Authorized Official Telephone Number:
678-462-5760

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com