Provider Demographics
NPI:1992353999
Name:GREATER GAINESVILLE COUNSELING & WELLNESS CENTER
Entity type:Organization
Organization Name:GREATER GAINESVILLE COUNSELING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-234-6712
Mailing Address - Street 1:4130 NW 37TH PL STE BOFFICE1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8152
Mailing Address - Country:US
Mailing Address - Phone:352-234-6712
Mailing Address - Fax:
Practice Address - Street 1:4130 NW 37TH PL STE BOFFICE1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8152
Practice Address - Country:US
Practice Address - Phone:352-359-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty