| Organization Name: | COMMUNITY COUNSELING AND WELLNESS SERVICES, INC |
| NPI Number: | 1427322213 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILIP A KIRK (OWNER) |
| Mailing Address: | 525 E North St Suite B Bradley |
| State: | IL US |
| Postal Code: | 609151185 |
| Phone Number: | 8159330667 |
| Fax Number: | 8159330665 |
| NPI Enumeration Date: | 02/27/2012 |
| NPI Last Update Date: | 02/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180007481 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |