Organization
CENTER FOR INTEGRATED WELL BEING INC
Active
Organization
CENTER FOR INTEGRATED WELL BEING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFRY DAVID JEANETTA WARK MA LICSW (OWNER)
(651) 698-0768
Entity
Organization
Contact information
Practice address
1449 GRAND AVE, SAINT PAUL, MN 55105-2206
(651) 698-0768
(651) 698-0660
Mailing address
1449 GRAND AVE, SAINT PAUL, MN 55105-2206
(651) 698-0768
(651) 698-0660
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13GS2WA
BCBS
—
01
—
483889
VALUE OPTIONS
—
Enumeration date
11/20/2006
Last updated
08/22/2020
Update your record
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