Healthcare Provider Details

I. General information

NPI: 1821033390
Provider Name (Legal Business Name): WELLSPRING COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18245 PAULSON DR SUITE 111
PT CHARLOTTE FL
33954-1019
US

IV. Provider business mailing address

3284 HIGHLANDS RD
PUNTA GORDA FL
33983-3549
US

V. Phone/Fax

Practice location:
  • Phone: 941-916-0522
  • Fax: 941-206-2201
Mailing address:
  • Phone: 941-916-0522
  • Fax: 941-206-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW0004869
License Number StateFL

VIII. Authorized Official

Name: MS. LINDA MARIE WESER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 941-916-0522