Provider Demographics
NPI:1154894376
Name:REGIONAL PSYCHOLOGY AND WELLNESS, LLC
Entity type:Organization
Organization Name:REGIONAL PSYCHOLOGY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANOA
Authorized Official - Middle Name:DIONE
Authorized Official - Last Name:PRAAY
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:616-994-3389
Mailing Address - Street 1:4845 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-8573
Mailing Address - Country:US
Mailing Address - Phone:231-924-6920
Mailing Address - Fax:231-924-9170
Practice Address - Street 1:4845 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8573
Practice Address - Country:US
Practice Address - Phone:231-924-6920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty