Provider Demographics
NPI:1881850030
Name:CENTER FOR WELLNESS: COMMUNITY COUNSELING, INC
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS: COMMUNITY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-597-1147
Mailing Address - Street 1:4452 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4604
Mailing Address - Country:US
Mailing Address - Phone:770-597-1147
Mailing Address - Fax:770-693-8619
Practice Address - Street 1:8333 OFFICE PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6937
Practice Address - Country:US
Practice Address - Phone:770-597-1147
Practice Address - Fax:770-693-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW 002206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00073767679BMedicaid
GA80BBFCPMedicare UPIN