Provider Demographics
NPI:1053117812
Name:RCW NEUROTHERAPY & WELLNESS CLINIC
Entity type:Organization
Organization Name:RCW NEUROTHERAPY & WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDDBORN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:346-459-9401
Mailing Address - Street 1:9000 SIX PINES DR # 164
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4271
Mailing Address - Country:US
Mailing Address - Phone:346-459-9401
Mailing Address - Fax:
Practice Address - Street 1:9000 SIX PINES DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-4271
Practice Address - Country:US
Practice Address - Phone:346-459-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty