Provider Demographics
NPI:1730999665
Name:WELLCREST THERAPY
Entity type:Organization
Organization Name:WELLCREST THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLADUNNI
Authorized Official - Middle Name:F
Authorized Official - Last Name:FAMINU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-495-7545
Mailing Address - Street 1:2100 RIVERSIDE PKWY STE 128
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5936
Mailing Address - Country:US
Mailing Address - Phone:470-495-7545
Mailing Address - Fax:
Practice Address - Street 1:3340 GARDENSIDE DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052
Practice Address - Country:US
Practice Address - Phone:470-495-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty