Healthcare Provider Details

I. General information

NPI: 1053704452
Provider Name (Legal Business Name): CORE HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUTLER ST SUITE 301
WEST PALM BEACH FL
33407-6036
US

IV. Provider business mailing address

200 BUTLER ST SUITE 301
WEST PALM BEACH FL
33407-6036
US

V. Phone/Fax

Practice location:
  • Phone: 561-502-4131
  • Fax:
Mailing address:
  • Phone: 561-502-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10291
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7624
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES W ANNEAR
Title or Position: CEO
Credential: LMHC
Phone: 561-502-4131