Healthcare Provider Details

I. General information

NPI: 1023701679
Provider Name (Legal Business Name): ADASKA THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/06/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 SUNBURST MARBLE RD
RIVERVIEW FL
33579-2119
US

IV. Provider business mailing address

11525 SUNBURST MARBLE RD
RIVERVIEW FL
33579-2119
US

V. Phone/Fax

Practice location:
  • Phone: 813-252-0978
  • Fax:
Mailing address:
  • Phone: 813-252-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAURA DELANEY
Title or Position: OWNER
Credential: LCSW
Phone: 813-252-0978