Healthcare Provider Details

I. General information

NPI: 1487355871
Provider Name (Legal Business Name): OMNIA TRAUMA HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PARTIN DR N
NICEVILLE FL
32578-1460
US

IV. Provider business mailing address

1603A PARTIN DR N
NICEVILLE FL
32578-1440
US

V. Phone/Fax

Practice location:
  • Phone: 850-460-7771
  • Fax:
Mailing address:
  • Phone: 850-460-7771
  • Fax: 850-660-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ALYSSA MARIE GAVULIC HOWK
Title or Position: FOUNDER/DIRECTOR
Credential: PHD, LMHC-S, LMFT-S
Phone: 850-460-7771