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General NPI Number Information
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NPI Number | 1063234219
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Entity Type | Organization
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Legal Business Name | COUNSELING DIMENSIONS
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 21075 QUESADA AVE PORT CHARLOTTE UNITED METHODIST CHU
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-625-4356
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Fax |
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Provider Business Mailing Address
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Address Line | 2186 RIO DE JANEIRO
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City | PUNTA GORDA
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State | FL
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Zip | 33983
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Country | US
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Telephone | 941-457-3442
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Fax |
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Authorized Official
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Title or Position | PRES/CEO
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Name | WADE M WARDEN
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Credential |
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Telephone | 941-457-3442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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