Healthcare Provider Details

I. General information

NPI: 1548752561
Provider Name (Legal Business Name): HWL HEAL WITH LOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 SAWDUST RD STE 1101
THE WOODLANDS TX
77380-2580
US

IV. Provider business mailing address

46 E SUNDANCE CIR
THE WOODLANDS TX
77382-5728
US

V. Phone/Fax

Practice location:
  • Phone: 281-889-0161
  • Fax: 281-419-1811
Mailing address:
  • Phone: 281-889-0161
  • Fax: 281-419-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number57200
License Number StateTX

VIII. Authorized Official

Name: MS. LEONIE M FERNANDO
Title or Position: MANAGER
Credential: LCSW
Phone: 281-889-0161