# TAILORED PSYCHIATRIC WELLNESS CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023872454
- **Authorized official:** TONIA WALLACE (OWNER)
- **Authorized official phone:** (623) 294-8804

## Contact information

- **Practice address:** 2818 QUEEN CITY DR STE E, CHARLOTTE, NC 28208-2736
- **Practice address phone:** (623) 294-8804
- **Mailing address:** 205 N MICHIGAN AVE, CHICAGO, IL 60601-5927
- **Mailing address phone:** (623) 294-8804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2024
- **Last updated:** 08/15/2026