Organization
COMMUNITY WELLNESS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ALLAN SIMMONS SR. (DIRECTOR/MANAGER)
(803) 586-1752
Entity
Organization
Contact information
Practice address
2430 ATLAS RD STE 1, COLUMBIA, SC 29209-3625
(803) 586-1752
(877) 995-5934
Mailing address
7356 GARNERS FERRY RD SUITE 130, COLUMBIA, SC 29209-2178
(803) 586-1752
(877) 995-5934
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
111N00000X
Chiropractor
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP8968
—
SC
Enumeration date
02/28/2017
Last updated
12/07/2021
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