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General NPI Number Information
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NPI Number | 1881850030
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Entity Type | Organization
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Legal Business Name | CENTER FOR WELLNESS: COMMUNITY COUNSELING, INC
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 8333 OFFICE PARK DR SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6937
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Country | US
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Telephone | 770-597-1147
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Fax | 770-693-8619
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Provider Business Mailing Address
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Address Line | 4452 KINGS HWY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-4604
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Country | US
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Telephone | 770-597-1147
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Fax | 770-693-8619
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Authorized Official
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Title or Position | PRESIDENT/THERAPIST
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Name | MS. CAROL A WHEELER
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Credential | LCSW
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Telephone | 770-597-1147
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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 | CSW 002206
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License Number State | GA
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