Provider Demographics
NPI:1841985900
Name:GENERATIONS WELLNESS CENTER
Entity type:Organization
Organization Name:GENERATIONS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOLODCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-477-7472
Mailing Address - Street 1:26803 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-4075
Mailing Address - Country:US
Mailing Address - Phone:586-477-7472
Mailing Address - Fax:
Practice Address - Street 1:26803 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-4075
Practice Address - Country:US
Practice Address - Phone:586-477-7472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty