=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598588667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR HEALTH AND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2024
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 PENNY LN
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-515-0955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 597
-----------------------------------------------------
City | HARKERS ISLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28531-0597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-515-0955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | PROF. JODI ANN KOHUT
-----------------------------------------------------
Credential | NCC, LCMHC
-----------------------------------------------------
Telephone | 252-515-0955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------