MEDICARE: ALPHA WELLNESS APPROACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629817283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA WELLNESS APPROACH

Provider Business Mailing Address
First Line	:	628 NE 139TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3141
Country	:	US
Telephone Number	:	786-925-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 NE 139TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3141
Country	:	US
Telephone Number	:	786-925-4656
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	JINIA WILLIAMS
Credential	:	LMHC
Telephone Number	:	786-925-4656

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/23/2024

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