Provider Demographics
NPI:1881047041
Name:COMMUNITY WELLNESS COUNSELING AND SUPPORT SERVICES
Entity type:Organization
Organization Name:COMMUNITY WELLNESS COUNSELING AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINTER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-643-7724
Mailing Address - Street 1:10611 NW STATE ROAD 20
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3441
Mailing Address - Country:US
Mailing Address - Phone:850-643-1033
Mailing Address - Fax:850-643-5066
Practice Address - Street 1:10611 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3441
Practice Address - Country:US
Practice Address - Phone:850-643-1033
Practice Address - Fax:850-643-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11921252Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020917500Medicaid