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Organization
TAILORED PSYCHIATRIC WELLNESS CENTER
Active
Organization
TAILORED PSYCHIATRIC WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONIA WALLACE (OWNER)
(623) 294-8804
Entity
Organization
Contact information
Practice address
2818 QUEEN CITY DR STE E, CHARLOTTE, NC 28208-2736
(623) 294-8804
Mailing address
205 N MICHIGAN AVE, CHICAGO, IL 60601-5927
(623) 294-8804
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
08/15/2026
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