Provider Demographics
NPI:1285142711
Name:THE COMMUNITY WELLNESS PROJECT
Entity type:Organization
Organization Name:THE COMMUNITY WELLNESS PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-421-9600
Mailing Address - Street 1:906 OLIVE STREET
Mailing Address - Street 2:SUITE 904
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101
Mailing Address - Country:US
Mailing Address - Phone:314-421-9600
Mailing Address - Fax:314-421-9603
Practice Address - Street 1:906 OLIVE STREET
Practice Address - Street 2:SUITE 904
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101
Practice Address - Country:US
Practice Address - Phone:314-421-9600
Practice Address - Fax:314-421-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty