Organization
BLACK WILLOW HOLISTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE ULLERY SBD (OWNER)
(618) 292-8518
Entity
Organization
Contact information
Practice address
301 OGLESBY ST, SALEM, IL 62881-2724
(618) 292-8518
Mailing address
301 OGLESBY ST, SALEM, IL 62881-2724
(618) 292-8518
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
12/12/2023
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