# HEADSPACE & WELLNESS CLINIC PLLC

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

## Provider details

- **NPI number:** 1811680390
- **Authorized official:** MARTHA L ESEH PMHNP (MANAGING DIRECTOR)
- **Authorized official phone:** (804) 350-5824

## Contact information

- **Practice address:** 2509A LEWISVILLE CLEMMONS RD \# 1012, CLEMMONS, NC 27012-8712
- **Practice address phone:** (704) 703-3417
- **Mailing address:** 196 ARNOLD PALMER DR, ADVANCE, NC 27006-7310
- **Mailing address phone:** (804) 350-5824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0809X | Adult Psychiatric/Mental Health Registered Nurse | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/31/2023
- **Last updated:** 09/02/2025