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General NPI Number Information
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NPI Number | 1700609625
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Entity Type | Organization
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Legal Business Name | CULTIVATING MENTAL WELLNESS
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 10831 KENSINGTON PARK AVE
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City | RIVERVIEW
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State | FL
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Zip | 33578-4496
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Country | US
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Telephone | 727-504-7198
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Fax |
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Provider Business Mailing Address
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Address Line | 10312 BLOOMINGDALE AVE STE 108 PMB 115
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City | RIVERVIEW
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State | FL
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Zip | 33578
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Country | US
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Telephone | 727-504-7198
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHASITY CHAMBLISS
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Credential |
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Telephone | 727-504-7198
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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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