Healthcare Provider Details

I. General information

NPI: 1003529553
Provider Name (Legal Business Name): IGW INSTITUTE FOR GROWTH & WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 ORANGE DR
DAVIE FL
33330-4341
US

IV. Provider business mailing address

12401 ORANGE DR
DAVIE FL
33330-4341
US

V. Phone/Fax

Practice location:
  • Phone: 954-928-6445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. EDWIGE JACQUES-PARENT
Title or Position: CEO/CLINICAL EXECUTIVE
Credential: ED.D, LMHC
Phone: 954-928-6445