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General NPI Number Information
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NPI Number | 1871200907
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Entity Type | Organization
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Legal Business Name | COREBELLA HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 5700 W OLIVE AVE STE 106
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City | GLENDALE
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State | AZ
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Zip | 85302-3147
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Country | US
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Telephone | 480-409-0322
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Fax | 877-559-2816
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Provider Business Mailing Address
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Address Line | 4600 MONTGOMERY RD STE 400
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City | CINCINNATI
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State | OH
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Zip | 45212-2600
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Country | US
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Telephone | 833-510-4357
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHAD SMITH
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Credential |
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Telephone | 833-510-4357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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