Provider Demographics
NPI:1679959837
Name:NEW RIVER WELLNESS, PA
Entity type:Organization
Organization Name:NEW RIVER WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHEILA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:TINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-546-5577
Mailing Address - Street 1:143 SEA GULL LN
Mailing Address - Street 2:
Mailing Address - City:N TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28460-8289
Mailing Address - Country:US
Mailing Address - Phone:859-230-0860
Mailing Address - Fax:910-338-0515
Practice Address - Street 1:15444 US HIGHWAY 17 NORTH
Practice Address - Street 2:BLDG 233
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-546-5577
Practice Address - Fax:910-338-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty