| Active Wellness Group Llc | |
|
605 S Main St Trenton FL 32693-3236 | |
| (386) 507-5789 | |
| Not Available |
| Full Name | Active Wellness Group Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 605 S Main St, Trenton, Florida |
| Authorized Official Name and Position | Kimberly Carpenter Herring (OWNER) |
| Authorized Official Contact | 3863970696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Wellness Group Llc 605 S Main St Trenton FL 32693-3236 Ph: (386) 507-5789 | Active Wellness Group Llc 605 S Main St Trenton FL 32693-3236 Ph: (386) 507-5789 |
| NPI Number | 1336737675 |
|---|---|
| Provider Enumeration Date | 01/04/2021 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336737675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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