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General NPI Number Information
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NPI Number | 1003212093
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Entity Type | Organization
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Legal Business Name | WHOLE AGAIN INSTITUTE FOR WELLNESS
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 14601 HOTEL ROAD SUITE 101B
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-933-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 14601 HOTEL ROAD (29TH ST) SUITE 101B
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-933-8299
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA RIVERA
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Credential | PSY D
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Telephone | 954-933-8299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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