Healthcare Provider Details

I. General information

NPI: 1780588285
Provider Name (Legal Business Name): WANDERINGS VENTURE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 VIA AUGUSTA DR
CONROE TX
77301-3385
US

IV. Provider business mailing address

3120 SOUTHWEST FWY STE 101 PMB 738749
HOUSTON TX
77098-4520
US

V. Phone/Fax

Practice location:
  • Phone: 617-913-6410
  • Fax:
Mailing address:
  • Phone: 617-913-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CASSANDRA LYNN AYALA
Title or Position: OWNER
Credential:
Phone: 617-913-6410