Provider Demographics
NPI:1386262053
Name:1A WELLNESS, LLC
Entity type:Organization
Organization Name:1A WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-817-5237
Mailing Address - Street 1:225 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1459
Mailing Address - Country:US
Mailing Address - Phone:617-817-5237
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984-1459
Practice Address - Country:US
Practice Address - Phone:617-817-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)