# COMMUNITY WELLNESS GROUP LLC

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

## Provider details

- **NPI number:** 1982144606
- **Authorized official:** MR. KENNETH ALLAN SIMMONS SR. (DIRECTOR/MANAGER)
- **Authorized official phone:** (803) 586-1752

## Contact information

- **Practice address:** 2430 ATLAS RD STE 1, COLUMBIA, SC 29209-3625
- **Practice address phone:** (803) 586-1752
- **Practice address fax:** (877) 995-5934
- **Mailing address:** 7356 GARNERS FERRY RD SUITE 130, COLUMBIA, SC 29209-2178
- **Mailing address phone:** (803) 586-1752
- **Mailing address fax:** (877) 995-5934

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | — | NULL | — |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 02/28/2017
- **Last updated:** 12/07/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP8968 | — | SC |