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General NPI Number Information
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NPI Number | 1043830425
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Entity Type | Organization
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Legal Business Name | GODDESS HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 5420 HOLLYWOOD BLVD APT 111
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6481
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Country | US
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Telephone | 754-300-7591
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Fax | 954-206-0496
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Provider Business Mailing Address
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Address Line | PO BOX 4223
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City | FORT LAUDERDALE
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State | FL
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Zip | 33338-4223
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Country | US
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Telephone | 754-300-7591
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Fax | 954-206-0496
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Authorized Official
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Title or Position | OWNER/FOUNDER/MEMBER MANAGER
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Name | TOMEKA CONSWELLO DAVIS
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Credential |
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Telephone | 954-848-7104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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