Healthcare Provider Details

I. General information

NPI: 1467609388
Provider Name (Legal Business Name): PHOENIX CENTER FOR HEALING P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11060 N KENDALL DR SUITE 7
MIAMI FL
33176-1272
US

IV. Provider business mailing address

14875 SW 238TH ST
HOMESTEAD FL
33032-8702
US

V. Phone/Fax

Practice location:
  • Phone: 305-345-3498
  • Fax: 305-257-0040
Mailing address:
  • Phone: 786-236-7927
  • Fax: 305-257-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP 2344
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS888
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7474
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT HAFNER
Title or Position: REGISTER AGENT FLORIDA CORP
Credential: MENTAL HEALTH COUNSE
Phone: 786-236-7927