Healthcare Provider Details

I. General information

NPI: 1376712372
Provider Name (Legal Business Name): GW & ASSOCIATES/A WELLNESS ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5142 KADENA AFB OKINAWA JAPAN
APO AP
96368-5142
US

IV. Provider business mailing address

PSC 80 BOX 14578 APO AP
OKINAWA KADENA AFB
96367
JP

V. Phone/Fax

Practice location:
  • Phone: 816117328210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA62970001A
License Number StateIL

VIII. Authorized Official

Name: GAIL WELLS
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, CADC
Phone: 3123124289589