Organization
BELOVED WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINIQUE PRITCHETT PSY.D., LCSW, CSAC (OWNER/DIRECTOR)
(262) 496-8897
Entity
Organization
Contact information
Practice address
3535 30TH AVE STE 207, KENOSHA, WI 53144-1632
(262) 496-8897
Mailing address
3535 30TH AVE STE 207, KENOSHA, WI 53144-1632
(262) 496-8897
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356605323
—
WI
Enumeration date
03/02/2020
Last updated
03/16/2020
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