Healthcare Provider Details

I. General information

NPI: 1518508100
Provider Name (Legal Business Name): WELLNESS CENTER FOR HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 N FEDERAL HWY STE B
POMPANO BEACH FL
33062-1032
US

IV. Provider business mailing address

1990 N FEDERAL HWY STE B
POMPANO BEACH FL
33062-1032
US

V. Phone/Fax

Practice location:
  • Phone: 561-252-9389
  • Fax: 954-366-1430
Mailing address:
  • Phone: 561-252-9389
  • Fax: 954-366-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA V HEWITT
Title or Position: CEO
Credential:
Phone: 561-252-9389