Community Wellness and Rehab, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

COMMUNITY WELLNESS AND REHAB, LLC

Practice address

25911 Sandy Creek CT
Gulfport, MS 39503-7014

Phone

(337) 853-2292

NPI assigned

Dec 16, 2024

Last updated

Dec 18, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Terrance Joseph Skidmore, LCSWNPI 1851697635

Title

Director, LCSW

Phone

(337) 853-2292

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terrance Joseph Skidmore, LCSW

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1851697635
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1093522864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25911 SANDY CREEK CT",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395037014",
            "telephone_number": "337-853-2292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25911 SANDY CREEK CT",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395037014",
            "telephone_number": "337-853-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY WELLNESS AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "SKIDMORE",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR, LCSW",
        "authorized_official_telephone_number": "337-853-2292",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.