Provider Demographics
NPI:1578376687
Name:LIMINAL WELLNESS COMPANY
Entity type:Organization
Organization Name:LIMINAL WELLNESS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:330-933-6525
Mailing Address - Street 1:214 SEDONA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2462
Mailing Address - Country:US
Mailing Address - Phone:330-933-6525
Mailing Address - Fax:
Practice Address - Street 1:214 SEDONA DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2462
Practice Address - Country:US
Practice Address - Phone:330-933-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty