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General NPI Number Information
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NPI Number | 1902207145
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Entity Type | Organization
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Legal Business Name | THE COMMUNITY MENTAL WELLNESS CENTER
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 1210 W DEL WEBB BLVD
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5224
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Country | US
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Telephone | 813-777-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 W DEL WEBB BLVD
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDMOND DUBREUIL
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Credential |
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Telephone | 813-777-9777
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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 | SW12131
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License Number State | FL
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