# CENTER STATE WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215646039
- **Authorized official:** RUSSELL ALLEN HOWARD (APRN)
- **Authorized official phone:** (603) 556-7101

## Contact information

- **Practice address:** 60 COMMERCIAL ST STE 303, CONCORD, NH 03301-5096
- **Practice address phone:** (603) 556-7101
- **Practice address fax:** (949) 404-6458
- **Mailing address:** 60 COMMERCIAL ST STE 303, CONCORD, NH 03301-5096
- **Mailing address phone:** (603) 556-7101
- **Mailing address fax:** (949) 404-6458

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/21/2022
- **Last updated:** 01/25/2024