Healthcare Provider Details

I. General information

NPI: 1477318566
Provider Name (Legal Business Name): DCB WELLNESS HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 25TH AVE
LONGVIEW WA
98632-1215
US

IV. Provider business mailing address

253 25TH AVE
LONGVIEW WA
98632-1215
US

V. Phone/Fax

Practice location:
  • Phone: 678-760-6321
  • Fax:
Mailing address:
  • Phone: 678-760-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY CHADIKA BURRELL
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 678-760-6321