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General NPI Number Information
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NPI Number | 1821033390
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Entity Type | Organization
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Legal Business Name | WELLSPRING COUNSELING CENTER INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 18245 PAULSON DR SUITE 111
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City | PT CHARLOTTE
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State | FL
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Zip | 33954-1019
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Country | US
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Telephone | 941-916-0522
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Fax | 941-206-2201
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Provider Business Mailing Address
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Address Line | 3284 HIGHLANDS RD
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City | PUNTA GORDA
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State | FL
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Zip | 33983-3549
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Country | US
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Telephone | 941-916-0522
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Fax | 941-206-2201
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LINDA MARIE WESER
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Credential | LCSW
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Telephone | 941-916-0522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW0004869
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License Number State | FL
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