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General NPI Number Information
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NPI Number | 1760075634
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Entity Type | Organization
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Legal Business Name | CENTER FOR BLACK WELLNESS & EXCELLENCE SOCIAL PURPOSE CORPORATION
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 473 E. CARNEGIE DR. SUITE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-505-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 473 E CARNEGIE DRIVE SUITE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-505-0557
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | SHARMELLE PARKER
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Credential | MSW
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Telephone | 909-505-0557
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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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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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