Provider Demographics
NPI:1083432140
Name:WELLNESS WAVE CORPORATION
Entity type:Organization
Organization Name:WELLNESS WAVE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAFAYAT
Authorized Official - Middle Name:OLABISI
Authorized Official - Last Name:BELLO-OGUNDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-232-9182
Mailing Address - Street 1:1935 W PRATT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2251
Mailing Address - Country:US
Mailing Address - Phone:301-820-5593
Mailing Address - Fax:
Practice Address - Street 1:1935 W PRATT ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2251
Practice Address - Country:US
Practice Address - Phone:301-820-5593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty