Organization
NUTRITIONAL & PSYCHOLOGICAL WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AUDREY SUZANNE CONNELL MA, LPC (OWNER, LICENSED PROFESSIONAL COUNSE)
(864) 735-0842
Entity
Organization
Contact information
Practice address
107 E PARK AVE, GREENVILLE, SC 29601-1631
(864) 735-0842
Mailing address
69 SIKES CIR, MAULDIN, SC 29662-2590
(716) 628-8250
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376895821
CIGNA
SC
05
—
1376895821
—
SC
Enumeration date
09/01/2021
Last updated
09/01/2021
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