Healthcare Provider Details

I. General information

NPI: 1164057907
Provider Name (Legal Business Name): SYNERGY WELLNESS CENTERS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17340 NW 27TH AVE
MIAMI GARDENS FL
33056-4065
US

IV. Provider business mailing address

17340 NW 27TH AVE
MIAMI GARDENS FL
33056-4065
US

V. Phone/Fax

Practice location:
  • Phone: 786-255-0613
  • Fax:
Mailing address:
  • Phone: 786-953-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ERICKA P CARDOSO
Title or Position: CEO
Credential: MS
Phone: 786-255-0613