Healthcare Provider Details

I. General information

NPI: 1275004608
Provider Name (Legal Business Name): CENTER FOR DYNAMIC HEALING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40946 US HIGHWAY 19 N # 421
TARPON SPRINGS FL
34689-5446
US

IV. Provider business mailing address

40946 US HIGHWAY 19 N # 421
TARPON SPRINGS FL
34689-5446
US

V. Phone/Fax

Practice location:
  • Phone: 224-828-9877
  • Fax:
Mailing address:
  • Phone: 224-828-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: LYNN LEANN BARRETTE
Title or Position: DIRECTOR
Credential:
Phone: 224-828-9877