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Organization
VITALITY WELL MENTAL HEALTH PROVIDERS INC
Active
Organization
VITALITY WELL MENTAL HEALTH PROVIDERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE MBAWUIKE (OWNER)
(857) 437-8574
Entity
Organization
Contact information
Practice address
3 ALLIED DR STE 311, DEDHAM, MA 02026-6148
(857) 437-8574
Mailing address
3 ALLIED DR STE 311, DEDHAM, MA 02026-6148
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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