Healthcare Provider Details

I. General information

NPI: 1871136317
Provider Name (Legal Business Name): SYSTEMIC SOLUTIONS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S UNIVERSITY DR STE 206
PLANTATION FL
33324-4001
US

IV. Provider business mailing address

1333 S UNIVERSITY DR STE 206
PLANTATION FL
33324-4001
US

V. Phone/Fax

Practice location:
  • Phone: 954-595-2666
  • Fax:
Mailing address:
  • Phone: 954-595-2666
  • Fax:

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. AYALA WINER
Title or Position: DIRECTOR/OWNER
Credential: PH.D
Phone: 954-292-8772