| Name: | Holistic Wellness Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Series Ltd. Liability Company |
| Status: | Exists |
| Date of registration: | 11 Apr 2021 (4 years ago) (Companies founded in April 2021) |
| Entity Number: | 000-846-227 |
| Register Number: | 000846227 |
| ZIP code: | 35085 (Companies in Chilton, 35085) |
| County: | Chilton |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 125 Cobb DrJemison, AL 35085 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891369823 | 2021-05-14 | 2021-12-31 | 125 COBB DR, JEMISON, AL, 350854197, US | 808 LAY DAM RD, CLANTON, AL, 350452943, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-430-9966 |
| Fax | 9152231562 |
| Phone | +1 205-369-1273 |
| Fax | 2053691273 |
Authorized person
| Name | MELISSA ASHLEY |
| Role | PRESCRIBER/MEMBER |
| Phone | 2054309966 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 270189 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| Ashley, Melissa | Agent | 125 Cobb Dr.Jemison, AL 35085 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
