Provider Demographics
NPI:1710692793
Name:WELLMIND LIVING
Entity type:Organization
Organization Name:WELLMIND LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:BREWSTER
Authorized Official - Last Name:LINEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-200-5421
Mailing Address - Street 1:180 W MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2304
Mailing Address - Country:US
Mailing Address - Phone:276-200-4521
Mailing Address - Fax:540-380-0123
Practice Address - Street 1:180 W MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2304
Practice Address - Country:US
Practice Address - Phone:276-200-4521
Practice Address - Fax:540-380-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty