Provider Demographics
NPI:1871361352
Name:REPLENISHING WELLNESS, LLC
Entity type:Organization
Organization Name:REPLENISHING WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD-PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CRC
Authorized Official - Phone:618-347-4129
Mailing Address - Street 1:5850 MACKLIND AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3569
Mailing Address - Country:US
Mailing Address - Phone:618-347-4129
Mailing Address - Fax:618-247-4487
Practice Address - Street 1:807 W HIGHWAY 50 STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1856
Practice Address - Country:US
Practice Address - Phone:618-347-4129
Practice Address - Fax:618-247-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty