Provider Demographics
NPI:1053049544
Name:FOR WELLNESS, LLC
Entity type:Organization
Organization Name:FOR WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE TIERRA
Authorized Official - Middle Name:LACHE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-706-0748
Mailing Address - Street 1:10003 RUFFIAN WAY UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2088
Mailing Address - Country:US
Mailing Address - Phone:240-706-0748
Mailing Address - Fax:
Practice Address - Street 1:10003 RUFFIAN WAY UNIT B
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2088
Practice Address - Country:US
Practice Address - Phone:240-706-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty