Modern Wellness PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3512 Issued in NC

Legal business name

MODERN WELLNESS PLLC

Practice address

1107F W Broad St
Elizabethtown, NC 28337-9483

Phone

(910) 862-4009

Fax

(910) 862-6004

NPI assigned

May 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kristi Starr Baldwin Rooks, MA, LPC

Title

Owner

Phone

(910) 914-0011

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1144496365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2482",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283372482",
            "telephone_number": "910-862-4009",
            "fax_number": "910-862-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107F W BROAD ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379483",
            "telephone_number": "910-862-4009",
            "fax_number": "910-862-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-07",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "ROOKS",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "STARR BALDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-914-0011",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APPLYING FOR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Elizabethtown, NC
• Providers in Elizabethtown, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.