Healthcare Provider Details

I. General information

NPI: 1639746068
Provider Name (Legal Business Name): WENDINA EYMA MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NW 167TH ST
MIAMI GARDENS FL
33056-4838
US

IV. Provider business mailing address

496 NW 165TH STREET RD APT D608
MIAMI FL
33169-6452
US

V. Phone/Fax

Practice location:
  • Phone: 305-624-7450
  • Fax:
Mailing address:
  • Phone: 786-985-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: