Provider Demographics
NPI:1497989842
Name:THE FAMILY WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:THE FAMILY WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:252-814-5464
Mailing Address - Street 1:7062 CHERRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-8398
Mailing Address - Country:US
Mailing Address - Phone:252-814-5464
Mailing Address - Fax:252-215-9012
Practice Address - Street 1:1025B DIRECTOR CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5996
Practice Address - Country:US
Practice Address - Phone:252-215-9011
Practice Address - Fax:252-215-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1133106H00000X
NC2000014352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917408Medicaid
NC6006254Medicaid
NC6006792Medicaid