# ELLEN J MATHESON FUNCTIONAL WELLNESS SOLUTIONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** eljema wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417404302
- **Authorized official:** ELLEN J MATHESON MS, CNS, LMT (CERTIFIED NUTRITION SPECIALIST)
- **Authorized official phone:** (843) 410-8567

## Contact information

- **Practice address:** 621 WAPPOO RD, SEED OF LIFE COLLECTIVE, CHARLESTON, SC 29407-1800
- **Practice address phone:** (843) 410-8567
- **Mailing address:** 2948 CATHEDRAL LN, CHARLESTON, SC 29414-7309
- **Mailing address phone:** (843) 324-5736

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | Yes |
| 133NN1002X | Nutrition Education Nutritionist | — | — | Yes |
| 174H00000X | Health Educator | — | NULL | — |
| 174H00000X | Health Educator | — | — | — |

## Other

- **Enumeration date:** 09/08/2016
- **Last updated:** 09/08/2016