Healthcare Provider Details

I. General information

NPI: 1750293817
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL HEALTH AND WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 INDUSTRIAL ST STE 200
LEESBURG FL
34748-3611
US

IV. Provider business mailing address

2620 INDUSTRIAL ST STE 200
LEESBURG FL
34748-3611
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-0499
  • Fax:
Mailing address:
  • Phone: 352-787-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: WANDRETTA L L DUDLEY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 350-409-0919