Provider Demographics
NPI:1902117815
Name:THE FAMILY WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:THE FAMILY WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CNHP, CBS
Authorized Official - Phone:901-672-7134
Mailing Address - Street 1:7503 QUEENS CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3875
Mailing Address - Country:US
Mailing Address - Phone:901-672-7134
Mailing Address - Fax:901-672-7136
Practice Address - Street 1:7503 QUEENS CT
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3875
Practice Address - Country:US
Practice Address - Phone:901-672-7134
Practice Address - Fax:901-672-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty