Provider Demographics
NPI:1174120513
Name:WELLS OF WELLNESS, LLC
Entity type:Organization
Organization Name:WELLS OF WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEANNETTA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MONTISSOL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:857-204-6773
Mailing Address - Street 1:40 CHARME AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3113
Mailing Address - Country:US
Mailing Address - Phone:857-204-6773
Mailing Address - Fax:
Practice Address - Street 1:993 SOUTH STREET
Practice Address - Street 2:APT, SUITE, FLOOR, ETC.
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:857-204-6773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty