| Council For Community Wellness | |
|
1148 N Broad St Ne Rome GA 30161-5209 | |
| (678) 744-8336 | |
| Not Available |
| Full Name | Council For Community Wellness |
|---|---|
| Speciality | Counselor |
| Location | 1148 N Broad St Ne, Rome, Georgia |
| Authorized Official Name and Position | John Kennebrew (CEO) |
| Authorized Official Contact | 6787448336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Council For Community Wellness 2037 Reynolds Dr Sw Atlanta GA 30315-6038 Ph: () - | Council For Community Wellness 1148 N Broad St Ne Rome GA 30161-5209 Ph: (678) 744-8336 |
| NPI Number | 1881138881 |
|---|---|
| Provider Enumeration Date | 12/09/2016 |
| Last Update Date | 12/09/2016 |
| Medicare PECOS PAC ID | 3072882851 |
|---|---|
| Medicare Enrollment ID | O20170711001215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881138881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Edward Valentin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821432444 PECOS PAC ID: 7517236391 Enrollment ID: I20170712002048 |
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