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General NPI Number Information
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NPI Number | 1508649161
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Entity Type | Organization
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Legal Business Name | COUNSELING FOR COMMUNITY WELLNESS INC.
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 908 ROBERTS AVE W
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City | IMMOKALEE
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State | FL
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Zip | 34142-3602
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Country | US
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Telephone | 941-500-3682
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1270
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City | BONITA SPRINGS
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State | FL
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Zip | 34133-1270
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND PRESIDENT
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Name | ALISE BARTLEY
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Credential | PHD
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Telephone | 239-258-0067
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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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