Healthcare Provider Details

I. General information

NPI: 1851620926
Provider Name (Legal Business Name): WTJ AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 WILES RD STE 105A
CORAL SPRINGS FL
33067-2064
US

IV. Provider business mailing address

7551 WILES RD STE 105A
CORAL SPRINGS FL
33067-2064
US

V. Phone/Fax

Practice location:
  • Phone: 561-797-0480
  • Fax: 754-240-4953
Mailing address:
  • Phone: 561-797-0480
  • Fax: 754-240-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number17-06-AD-747201
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1706AD747201
License Number StateFL

VIII. Authorized Official

Name: DAVID D HAYWARD
Title or Position: PRESIDENT
Credential: LMHC MCAP
Phone: 561-797-0480