Healthcare Provider Details

I. General information

NPI: 1265161327
Provider Name (Legal Business Name): CULLOWHEE COMMUNITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S COUNTRY CLUB DR
CULLOWHEE NC
28723-6864
US

IV. Provider business mailing address

1015 S COUNTRY CLUB DR
CULLOWHEE NC
28723-6864
US

V. Phone/Fax

Practice location:
  • Phone: 727-538-4208
  • Fax: 727-538-4209
Mailing address:
  • Phone: 727-538-4208
  • Fax: 727-538-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: CLARK C CORWIN
Title or Position: OWNER/MEMBER
Credential: LCSW
Phone: 727-538-4208