Provider Demographics
NPI:1639918972
Name:COMMUNITY WELLNESS GROUP
Entity type:Organization
Organization Name:COMMUNITY WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERIES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:202-391-1307
Mailing Address - Street 1:6823 JADE CT
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1873
Mailing Address - Country:US
Mailing Address - Phone:202-391-1307
Mailing Address - Fax:
Practice Address - Street 1:6823 JADE CT
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1873
Practice Address - Country:US
Practice Address - Phone:202-391-1307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health