Provider Demographics
NPI:1194124933
Name:SAVVY WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:SAVVY WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, CSOTS
Authorized Official - Phone:866-736-6408
Mailing Address - Street 1:1235 EAST BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5876
Mailing Address - Country:US
Mailing Address - Phone:866-736-6408
Mailing Address - Fax:980-225-0506
Practice Address - Street 1:1235 EAST BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5876
Practice Address - Country:US
Practice Address - Phone:866-736-6408
Practice Address - Fax:980-225-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008679251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ470090281Medicare PIN