Healthcare Provider Details

I. General information

NPI: 1215819677
Provider Name (Legal Business Name): WINGS OF HOPE THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N 10TH ST STE A2
SAINT AUGUSTINE FL
32084-1872
US

IV. Provider business mailing address

415 ASHBY LANDING WAY
SAINT AUGUSTINE FL
32086-4351
US

V. Phone/Fax

Practice location:
  • Phone: 904-994-0903
  • Fax:
Mailing address:
  • Phone: 904-994-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN D MOLDOVANYI
Title or Position: OWNER/CEO
Credential: LMHC LMFT
Phone: 904-664-1999