Provider Demographics
NPI:1679894521
Name:PSYCHOTHERAPY CENTER FOR WELLNESS, LLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY CENTER FOR WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-536-5575
Mailing Address - Street 1:114 TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2740
Mailing Address - Country:US
Mailing Address - Phone:401-536-5575
Mailing Address - Fax:
Practice Address - Street 1:267 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3750
Practice Address - Country:US
Practice Address - Phone:401-536-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty