Healthcare Provider Details

I. General information

NPI: 1285142711
Provider Name (Legal Business Name): THE COMMUNITY WELLNESS PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 OLIVE STREET SUITE 904
ST. LOUIS MO
63101
US

IV. Provider business mailing address

906 OLIVE STREET SUITE 904
ST. LOUIS MO
63101
US

V. Phone/Fax

Practice location:
  • Phone: 314-421-9600
  • Fax: 314-421-9603
Mailing address:
  • Phone: 314-421-9600
  • Fax: 314-421-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANA P. WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-421-9600